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Surgery > ENT > Flashcards

ENT Flashcards

1
Q

What is a cholesteatoma?

A

An abnormal benign destructive growth of squamous epithelium in the middle ear and mastoid that may progressively enlarge to surround and destroy the ossicles, resulting in conductive hearing loss. May be congenital or acquired

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2
Q

Predisposing factors of cholesteatoma

A

Recurrent AOM or chronic OME
Older age at grommet insertion
Higher number of and interval between grommet insertions
Cleft palate
Craniofacial anomalies
Turner and Down Syndrome
Family history of chronic OME or cholesteatoma

Congenital forms are more common in boys

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3
Q

Presentation of cholesteatoma

A

Chronic ear drainage, new onset hearing loss (especially if after ear surgery)
Otoscopy: intact TM with white mass behind it, deep retraction pocked +/- granulation and skin debris, focal granulation tissue of TM, attic crust

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4
Q

Complications of cholesteatoma

A

Hearing loss secondary to destruction of intratemporal structures
CN palsies (VII, VI)
Neurological symptoms: e.g. vertigo
Venous thrombosis
Serious infection (brain abscess, meningitis)

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5
Q

Management of cholesteatoma

A

Complete excision with tympanoplasty +/- ossiculoplasty as indicated
Complications of surgery: hearing loss, CN VII paralysis, CSF leak, TM perforation

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6
Q

Differentials for hearing loss

A

Outer ear:
Foreign body, wax, AOE, trauma, ear canal pathology (e.g. osteoma, exostoses)
Middle ear:
OME, haemotympanum, ossicle discontinuity, trauma, barotrauma, iatrogenic, perforated DM, cholesteatoma
Inner ear:
Presbycusis, noise-induced, infective, trauma (temporal bone #), ototoxic drugs, AI (SLE, WG, UC) tumours (schwannoma, leukaemia, myeloma), vascular (CVA, sickle cell), perilymphatic fistula, barotrauma, neuro (MS, migraine), other (DM, sarcoid)

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7
Q

Vestibular Schwannoma: What is it, how common is it, presentation, diagnosis, management

A

A rare slow-growing, non-malignant tumour on CN VIII
Cause of 0.1% of unilateral hearing loss and tinnitus
Presentation: unilateral hearing loss and tinnitus (usually high-pitched, of similar frequency to hearing loss) and vertigo (initially minimal or transient)
Diagnosis with MRI or CT
Management: watchful waiting if contraindications to surgery, or surgical removal (up to 20% will have worsening tinnitus, 20-60% will remain unchanged, 30-50% improved or eliminated tinnitus)

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8
Q

Ototoxic drugs

A 
Aminoglycosides (e.g. gentamicin)
Aspirin
Cisplatin
Quinine
Frusemide
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9
Q

Perilymphatic fistula

What is it, what causes it, presentation, diagnosis, management

A

An abnormal connection between the inner and middle ear allowing leak of perilymph fluid into the middle ear compartment
Caused by a tear in the oval and/or round window (physical trauma, barotrauma, raised ICP, congenital anomaly of temporal bone)
Presentation: vertigo, fluctuating hearing loss, aural fullness, tinnitus, exacerbation of symptoms with changes in altitude, weather or exertion. Can sometimes see fluid behind membrane on otoscopy
Management with strict bed rest to allow fistula to close

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10
Q

Causes of vertigo

A

BPPV: vertigo for few seconds-minutes on movement of head (e.g. rolling over in bed)
Labyrinthitis: sudden, spontaneous onset + n&v + gait instability
Brainstem infarct: sudden onset, n&v
Cerebellar: sudden onset, prominent gait impairment, headache, dysphagia, uncoordination
Meniere disease: episodes lasting 20m-24h + hearing loss + tinnitus
Perilymphatic fistula, vestibular schwannoma

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11
Q

Labyrinthitis

Presentation, natural history, management

A

sudden spontaneous onset of vertigo + n&v + gait instability towards affected side (single episode)
spontaneous nystagmus away from affected side
+ve head thrust test (thrusting head to side of lesion, will not be able to remain fixed on visual target)
severe symptoms for few days, gradual diminution +/- residual symptoms for months -usually will only suffer once
Prednisolone (full dose 5 days then taper) + IM prochlorperazine or oral diazepam for symptomatic relief
MRI brain to exclude CVA

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12
Q

Meniere disease

Presentation, diagnosis, natural history, management

A

20-40y/o
Recurrent episodes (20m-24h) vertigo, sensorineural hearing loss, tinnitus
Diagnosis of exclusion
10% have intractable, progressive, unremitting symptoms
Symptomatic mx: hydrochlorothiazide, betahistine OR destructive tx: intratympanic gentamicin, labyrinthectomy Non-dest: intratympanic glucocorticoids

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13
Q

BPPV

Presentation and examination

A

Positional vertigo provoked by head movement

Recurrent episodes

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14
Q

Differentials for chronic otorrhoea

A 
chronic suppurative otitis media
cholesteatoma
ear foreign body
granuloma
immunodeficiency
neoplasm
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15
Q

Complications of CSOM

A 
hearing impairment - speech, language delay, poor school performance, psychosodial complications
cholesteatoma
meningitis, brain abscess
mastoiditis
facial n palsy
sigmoid sinus thrombosis
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16
Q

Diagnosis of CSOM

A

painless otorrhoea for >6weeks with evidence of perforated TM on otoscopy

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17
Q

BPPV natural history and management

A

Untreated episodes resolve spontaneously over days-weeks
Recurrences are common
Epley manoeuvres (particle repositioning manoeuvres) +/- stemetil as premedication to tolerate manoeuvres

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18
Q

Systematic assessment of tympanic membrane

A 
COMPLETE:
Colour
Other conditions (fluid level, bubbles, perforation, otorrhoea, bullae, tympanosclerosis)
Mobility
Position (retracted v bulging)
Lighting
Entire surface (examine all 4 quadrants)
Translucency
External auditory canal and auricle (e.g. deformed, displaced, inflamed, foreign body)
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19
Q

Definition of malignant or necrotising otitis externa

A

The spread of otitis externa to skull base causing perostitis and osteomyelitis

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20
Q

Risk factors for otitis externa

A

Bacterial:

  • kids (5-10), summer (water activities)
  • hearing aids, earphones, diving caps (any occlusion of ear canal)
  • dermatological conditions e.g. psoriasis

Malignant:

  • DM or ISS
  • very rare in children

Fungal:

  • 2-10% of OE
  • after treatment of bacterial infection
  • Candida more common in patients with hearing aids
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21
Q

Most common pathogen in malignant otitis externa

A

Pseudomonas aeruginosa

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22
Q

Clinical features in bacterial otitis externa

A

Severe otalgia
Reduced hearing
pruritus
minimal ear discharge

Oedematous, narrow, inflamed ear canal +/- pinna
Erythematous auricle and tragus
tender

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23
Q

Clinical features of malignant or necrotising otitis externa

A

Severe otalgia out of proportion to severity of ear canal swelling

  • tends to be nocturnal and extend to TMJ (esp on chewing)
  • Otorrhoea

Only mild swelling of EAC
Facial palsy +/- other cranial n palsies (once there is osteomyelitis)
granulation tissue on floor of EAC

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24
Q

Clinical features of fungal otitis externa

A

Severe otalgia, pruritus, minimal discharge
Aspergillus: fine, dark coating of EAC
Candida: white, sebaceous-like material

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25
Q

Complications of otitis externa

A

Malignant otitis externa

Fungal OE may lead to perforation

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26
Q

Invesitgations in malignant otitis externa

A

CT petrosal temporal bone
Ear swab
ESR, CRP
BGL/identify the underlying immunodeficiency

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27
Q

Management of otitis externa

A

Ear toilet - tissue spears
Otowick insertion with antibiotic/steroid drops for 7-10 days
suffudex = dexamethasone, framycetin, gramicidin (No anti-fungal activity)
Systemic antibiotics only if cellulitis of pinna/facial skin or fever
Simple analgesia
Water precaution for 2 weeks

If fungal:, must be cleaned thoroughly use antifungal/steroid (clioquinol/flumethasone) ear drops instead, fungal OE must be reviewed!

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28
Q

Indications for referring otitis external to ENT

A

Bacterial OE with no response to appropriate Otowick and antibiotic management
Malignant OE
Fungal OE

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29
Q

Definition of otitis media with effusion

A

Inflammation of the middle ear cleft accompanied by the accumulation of fluid without the symptoms and signs of acute inflammation

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30
Q

Clinical features of otitis media with effusion

A

Hearing loss (mild and fluctuating) - may interfere with language development, behaviour, school performance

Otoscopy:

  • Air-fluid level behind membrane
  • Opacification of TM (cloudy white/grey)
  • Retracted TM
  • reduced mobility of TM
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31
Q

Complications of otitis media with effusion

A
  • Tympanosclerosis
  • Retraction pocket
  • Cholesteatoma
  • TM perforation
  • Ossicular chain erosion
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32
Q

Investigations in otitis media with effusion

A

Tympanometry

Audometric assessment

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33
Q

Management of otitis media with effusion

A

Watchful waiting for 3 months (80-90% will spontaneously resolve in this time)

If lasting over 3 months with bilateral hearing loss or in setting of speech delay etc. = surgical therapy for ventilation (grommets, tubes etc.)

SPEECH AND LANGUAGE THERAPY - especially for those with developmental delay

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34
Q

Risk factors for otitis media with effusion

A 
family history of OM
Bottle feeding
Daycare attendance
Adenoidal hypertrophy
Cigarette smoke exposure
Low socioeconomic status
Cleft palate
Pacifier use
Reflux and allergy
Non-immunised status
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35
Q

Main pathogens responsible for mastoiditis

A

Streptococcus pneumoniae
Streptococcus pyogenes
Staphylococcus aureus

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36
Q

Clinical features of mastoiditis

A 
Ear pain (irritability in young children)
Postauricular tenderness, erythema, swelling, fluctuance or mass
Displacement of the auricle (usually downa nd out in kids under 2, up and out kids over 2)

Otoscopy may be normal or may be bulging TM + effusion or perforation

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37
Q

Complications of mastoiditis

A

Rate of complications 10-20%
s pyogenes associated with highest rate of complications at presentation

Subperiosteal abscess
Facial nerve palsy
Hearing loss
Labyrinthitis
Osteomyelitis
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38
Q

Management of mastoiditis

A

MUST CULTURE SPECIFIC BACTERIA
- Drainage of middle ear and/or mastoid cavity
- parenteral antibiotic therapy
If no history of recurrent AOM use vancomycin, if history of recurrent or recent antibiotic use combination therapy to cover P aeruginosa as well (e.g. bactrim or a cephalosporin + vancomycin

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39
Q

Indications for mastoidectomy in mastoiditis

A

Findings consistent with subperiosteal abscess
CT evidence of coalescent mastoiditis
Other suppurative complications
Acute mastoiditis in a child with chronic OME or cholesteatoma
Progression of symptoms despite IV antibiotics and appropriate drainage

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40
Q

definition of otosclerosis

A

Bony overgrowth involving the footplate of the stapes leading to fixation of the stapes, gradually reducing conduction through the ossicles and leading to conductive deafness

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41
Q

Cause of otosclerosis

A

Autosomal dominant inherited condition with variable penetrance (typically age of onset of noticeable hearing loss in 20s)

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42
Q

What is paracusis of Willis

A

The phenomenon of the apparent hearing improvement in a noisy environment for someone with conductive hearing loss (due to others speaking louder)

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43
Q

Pathognomic sign of otosclerosis

A

Schwartz sign - red blush over area anterior to oval window on otoscopy

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44
Q

Subjective v objective tinnitus

A

Subjective: phantom sensation only heard by the sufferer

Objective tinnitus: caused by real sounds generated in the body and transmitted to the ear by conduction through body tissue (e.g. vascular tumours, fistulae, clicking of myoclonus, ear waz, tensory tympani)

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45
Q

Causes of epistaxis

A
  • cold dry environment
  • infection
  • inflamamtion (rhinosinusitis, Wegener’s granulomatosis, polyposis)
  • trauma ( post-nasal surgery, septal perforation, picking, foreign bodies)
  • Neoplastic (juvenile nasoangiofibroma, lymphoma, nasopharyngeal carcinoma)
  • Systemic (bleeding diathesis, anti-coagulant medications, hereditary haemorrhagic telangiectasia)
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46
Q

Septal haematoma complications

A

Can become infected - inflammation - cartilage destruction - saddle deformity

OR infection can spread via blood vessels directly into skull and brain

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47
Q

Diagnostic test for CSF leak

A

Beta 2 transferrin

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48
Q

Locations of nose bleeds

A

Anterior bleed: Little’s area/Kisselbach’s plexus (anterior nasal septum)

Posterior bleed: Woodruff’s plexus OR sphenopalatine artery

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49
Q

Management of epistaxis

A

ABCs and basic first aid

Anterior:

  • Cauterisation with silver nitrate (use topical anaesthetic spray because painful)
  • Nasal packing (Rapid Rhinos)

Posterior:
- layered packing of all of nose (ensure to place pad under plug on outside of nose or will rapidly produce an ulcer)

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50
Q

Especially dangerous intranasal foreign objects

A

Button batteries (electrolysis at -ve pole produces OH ions - alkaline tissue necrosis, if -ve pole at septum causes perforation in less than 4 hours)

Paired disc magnets, one in each nostril attached at septum cannot be manually removed - chronic compression causes perforation (over weeks)

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51
Q

Management options for removal of intranasal foreign bodies

A

Most are removed by GP/mother/ED doctor easily

Positive pressure techniques:

  • soft or smooth FB totally occluding anterior nasal cavity
  • oral positive pressure by parent while occluding other nostril (if child too young to cooperate with nose blowing)

Instrumentation; for non-occlusive foreign bodies in anterior portion of nose

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52
Q

Acute v chronic rhinosinusitis

A 
Acute = less than 4 weeks duration
Chronic = more than 4 weeks duration
53
Q

Causes of rhinosinusitis

A

Mostly viral

  • rhinovirus
  • adenovirus
  • influenza
  • parainfluenza

Only 0.5-2% have bacterial involvement

  • S. pneumoniae
  • H. influenzae
  • M. catarrhalis

Exquisite facial tenderness early on or no improvement after 10 days likely to be bacterial

54
Q

Features of rhinosinusitis

A

Nasal congestion
Post-nasal drip
Facial pain, pressure or fullness
Reduces sense of smell

55
Q

Management of acute rhinosinusitis

A

Supportive treatment (as usually viral)
Topical corticosteroids reduce discharge and cough
- Budenoside (rhinocort) if older than 6y
- Mometasone (Nasonex) if older than 3y

TOPICAL OR ORAL DECONGESTANTS AND ANTIHISTAMINES ARE NOT EFFECTIVE

56
Q

Chronic rhinosinusitis management

A

Unless severe, no treatment usually necessary
Avoid triggers (allergies, smoke, day care)
Use saline sprays
Teach child to blow nose

If severe symptoms consider testing allergies, immunological assessment, cilial function
Tx: nasal saline and topical steroid sprays
Adenoidectomy if associated nasal obstruction

Most children will improve by 6-8 years mainly due to maturity of the immune system

57
Q

Prevalence of allergic rhinitis in the community

A

1/5 adults
1/10 teens
1/15 primary children

58
Q

Complications of allergic rhinitis

A

Sleep apnoea
Asthma exacerbations
More frequent sinus and middle ear infections
Impaired concentration, behaviour, slee, learning capacity, exercise tolerance

59
Q

Clinical features of allergic rhinitis

A 
Itchy nose
CLEAR rhinorrhoea
Sneezing
Nasal congestion
Postnasal drip
Cough (secondary to postnasal drip)
TIMING likely to give clue to allergen:
Seasonal: grass/weed/pollen/moulds
Perennial: likely indoor allergens (dust mites, pets, moulds)
60
Q

Classifying severity and duration of allergic rhinitis

A

Intermittent: less than 4 days per week OR for less than 4 consecutive weeks
Persistnent: More than 4 days per week AND more than 4 consecutive weeks

Severity:
Mild: no criteria meeting mod-sev
Mod-severe: Troublesome symptoms, sleep disturbance, impairment of ADLs, leisure or sport, impairment of school or work performance

61
Q

Physical findings in allergic rhinitis

A

Pale and boggy inferior turbinates
Posterior polyps
“allergic shiners” - dark circles under eyes due to lower eyelid venous stasis
“Allergic salute” - transverse nasal crease due to chronic upward wiping of nose

62
Q

Management of allergic rhinitis

A

According to symptom duration and severity
- Education, identification and avoidance of allergens
- Saline irrigation
- Oral antihistamines
- Intranasal antihistamines
- Intranasal corticosteroids
- Intranasal sodium cromoglycate
- Montelukast (children)
- Intranasal ipratropium
Review after 2-4 weeks, if no improvement increase steroid dose

depo steroid IM (celestone or depo medrol)
Last resort: immunotherapy (desensitisation 80-90% effective, response may be up to 5 years)

63
Q

Types of oral antihistamines (brand name and generic)

A

Cetirizine (Zyretc) - least likely to cause sedation
Loratadine (Claratyne)
Desloratadine (Clarinex)
Fexofenadine (Telfast)

64
Q

Intranasal antihistamines (generic and brand name)

A

Azelastine (Azep)

Levocabastine (livostin)

65
Q

Tips for using nasal spray effectively

A
  • Clear nasal passage first (?nasal saline spray may work)
  • Shake bottle and follow package re: priming
  • bend neck forward and look down
  • Use one hand over the opposite nostril
  • Put nozzle just inside the nose, aiming towards the outer wall
  • Avoid sniffing too hard (will just go to back of throat)
66
Q

Definitions of acute, subacute, chronic, recurrent acute sinusitis

A

Acute: less than 4 weeks with complete resolution of symptoms
Subacute: 4-12 weeks with complete resolution of symptoms
Chronic: inflammation more than 12 weeks with persistent URT symptoms
Recurrent acute: one episode of acute sinusitis every 12 months

67
Q

Factors predisposing to acute sinusitis

A 
Tumours
Polyps
Foreign bodies
Congenital choanal atresia
Allergies
Asthma
68
Q

Pathogens most commonly implicated in acute bacterial sinusitis

A

S. pneumoniae
H. influenzae
M. catarrhalis

Anaerobic infections seen more commonly in chronic sinusitis and in cases associated with dental infection

69
Q

Clinical features of sinusitis

A 
Cough
Purulent nasal secretion
Facial pain or pressure
Headache
Maxillary toothache
Ear fullness
Postnasal drip
Poor sense of smell
Poor response to decongestants 
(irritability and vomiting in children)

PAIN IS HALLMARK OF ACUTE SINUSITIS

70
Q

Investigations in sinusitis

A

None indicated for uncomplicated acute sinusitis

If chronic - distinguish from allergic rhinitis with CT

71
Q

Management of acute sinusitis

A

Amoxycillin + clavulanic acid for 5-7 days

72
Q

Definition of tonsillitis

A

An acute infection causing inflammation of the palatine tonsil +/- pharyngeal tonsils or adenoids

73
Q

Most common pathogen causing pharyngitis in children

A

Group A streptococcus (s. pyogenes)
20-30% of cases

Only responsible for 5-15% of pharyngitis in adults

74
Q

Groups at high risk for complications secondary to tonsillitis

A

2-25y/o in area with high incidence of ARF (e.g. indigenous communities)
Patients with existing rheumatic heart disease
Patients with scarlet fever

GIVE ANTIBIOTICS

75
Q

Complications of streptococcal tonsillitis

A 
Nonsuppurative:
- Scarlet fever
- Acute rheumatic fever
- Post-streptococcal glomerulonephritis
Suppurative:
- peritonsillar abscess (quinsy)
- Parapharyngeal space abscess
- retropharyngeal anscess
- Acute otitis media
- Acute sinusitis
76
Q

Management of tonsillitis

A

Supportive symptomatic relief
Antibiotic therapy: phenoxymethylpenicillin BD for 10 days

(if poor compliance suspected: benzathine penicillin IM single dose)

77
Q

Definition of quinsy

A

AKA peritonsillar abscess

An infection of the Weber’s glands which causes an abscess in the back of the throat, displacing the tonsils

78
Q

Pathogens in quinsy

A

Often polymicrobial

  • S. pyogenes
  • S. aureus
  • respiratory anaerobes
  • occassionally H. influenzae
79
Q

Clinical features of quinsy

A 
Unilateral throat pain
Trismus
Hot potato voice
Dysphagia, odynophagia
Neck pain
Referred ear pain
Fever
Inferior and medial displacement of ipsilateral tonsil
Downward displacement of swollen uvula
Tender cervical lymphadenopathy
Palatal oedema
80
Q

Management of quinsy

A

Drainage (incision or needle aspiration)
+/- quinsy tonsillectomy
IV cephazolin + metronidazole
Elective tonsillectomy if recurrent quinsy (10% risk) or history of recurrent tonsillitis

81
Q

Acute epiglottitis definition

A

A cellulitis of the epiglottis and adjacent supraglottic structure (aryepiglottic folds etc.) that can progress to life-threatening airway obstruction if left untreated

82
Q

Clinical features of acute epiglottitis in a child

A 
Abrupt onset and rapid progression (hospitalised within 12h)
3 Ds: Dysphagia, Drooling, Distress
High fever
Severe sore throat, odynophagia
Chokin sensation
Hot potato voice
Tripod position
Stridor
Tenderness of anterior neck
Cough
TEND NOT TO HAVE HOARSENSS
83
Q

Clinical features of epiglottitis in an adult

A

Slower progression than child (most present within 2 days)

  • sore throat or odynophagia
  • fever
  • muffled voice
  • drooling
  • stridor or respiratory compromise (far less common than in children)
  • hoarseness
84
Q

Management of acute epiglottitis

A

MEDICAL EMERGENCY IN CHILDREN
Secure airway ASAP (early ETT, have tracheostomy set at hand)
Adults: defer intubation, closely follow if no signs of current obstruction
Empiric antibiotics - Ceftriaxone or cefotaxime IV 5d
+/- dexamethasone single dose every 24h as required to reduce airway inflammation

85
Q

Risk factors for sialolithiasis

A 
Dehydration
Diuretics
Anti-cholinergic medications
Trauma
Gout 
Smoking
86
Q

What are sialoliths most commonly formed from

A

Calcium phosphate and hydroxyapatite

+ smaller amounts of Mg, K and ammonium

87
Q

Most common gland from which salivary stones arise

A

80& from submandibular glands
- largest, most often in the duct
(duct is long and flow of saliva is slow and against gravity + saliva more alkaline and higher Ca content)
20% Parotids - tend to be smaller, often multiple, often within the gland itself

88
Q

Salivary ducts names from each gland

A

Submandibular gland - Wharton’s duct

Parotid gland - Stensen’s duct

89
Q

Imaging in sialolithiasis

A

80-95% submandibular are radioopaque
only 60% parotid stones radiopaque
USS detects over 90% of stones
CT will pick up most stones PROVIDED FINE CUTS ARE REQUESTED so that small stones aren’t missed
Sialography - better at detecting other diagnoses (e.g. stricture, degeneration of duct etc.)

MRI will not visualise stones

90
Q

Complications of sialolithiasis

A

Sialadenitis
Salivary gland abscess
Airway compromise
Chronic sialadenitis

91
Q

Management of sialolithiasis

A

Stones under 2mm can generally be cleared non surgically

  • good hydration
  • moist heat to area
  • massage gland “milk” duct
  • avoid anticholinergic medications
  • Pain relief NSAIDs

Minimally invasive approaches:

  • extracorporeal or laser lithotripsy
  • sialendoscopy
  • wire basket retrieval

Surgical intervention

92
Q

What is a ranula

A

A retention cyst on the floor of the mouth secondary to damage of salivary duct and sublingual glands

93
Q

Differentials for lateral congenital neck mass

A

Branchial cleft cyst
Lymphatic/venous malformation
Cystic hygroma

94
Q

Differentials for midline congenital neck mass

A

Thyroglossal duct cyst
Dermoid cyst
Laryngocele

95
Q

differentials for acquired neck masses

A 
Inflammatory/infective
- reactive lymphadenopathy (tonsillitis etc.)
- Glandular fever
- Kawasaki disease etc.
- HIV
- salivary gland calculi
- sialadenitis
- thyroiditis
- Granulomatous disease (TB, sarcoid)
Neoplastic:
- lymphoma
- salivary gland or thyroid tumours
- metastatic malignancy
- Schwannoma
- lipoma
- benign skin cysts
96
Q

Symptoms to ask for in neck mass

A

Pain: ?rapid growth or expansion OR direct neural invasion of certain malignancies
Vocal changes or dysphagia: ?mets from upper aerodigestive tract malignancy
B-symptoms: ?lymphoma
High spiking fevers: acute infection

97
Q

Risk factors for primary head and neck cancer

A 
Cigarette smoking (10x)
Excessive alcohol consumption (5x)
HIV status
HPV: (oropharynx)
EBV (Nasopharynx)
HIV
Radiotherapy for local cancers
IVDU
Occupational exposure (dry cleaning, asbestos, pesticides, woodworkers, plastic and rupper products)
98
Q

Likely tissues involved for preauricular and angle of jaw masses

A

Salivary or lymphoid tissue in the parotid system

99
Q

Likely tissues involved for central neck masses

A

thyroid
Malignant secondary
Dermoid cyst

100
Q

Likely tissues involved for anterior aspect of SCM masses

A

High jugulo-digastric region
Malignancies common in adults
Congenital: 2nd branchial cleft cyst

101
Q

Likely tissues involved for posterior triangle neck masses

A

High suspicion for malignancy

Nasopharyngeal carcinoma

102
Q

investigations of neck mass

A

CT head, neck and chest BEFORE biopsy (if biopsy first, may cause a reactive lymphadenopathy)
FNA, core biopsy

103
Q

Definition of cyst

A

Persistent sinus with no external opening

104
Q

Definition of sinus

A

Blind-ended tract opening to one cavity

105
Q

Definition of fistula

A

Persistent communication between two cavities

106
Q

Definition of branchial cleft cyst

A

A congenital epithelial cyst that arises on the lateral part of the neck due to failure of obliteration of the 2nd (in 99% of cases) branchial cleft

107
Q

Location of second branchial cleft cysts

A

Just inferior to angle of mandible
Anterior to SCM
Superficial to carotid sheath
Dorsal to submandibular gland

108
Q

Clinical features of branchial cleft cyst

A

Neck mass anterior to SCM, just inferior to angle of mandible

  • smooth
  • painless
  • slowly enlarging, often after URTI
109
Q

Complications of branchial cleft cysts

A

Recurrent infections

Fistula tract to skin may develop

110
Q

Management of branchial cleft cyst

A

Surgical excision (ensure no active infection)

111
Q

epidemiology of branchial clet cysts

A

make up 20% of paediatric neck masses

112
Q

Aetiology of thyroglossal duct cysts

A

First and second pharyngeal pouches for foramen caecum of the tongue - descend in midline as thryoglossal tract to position of normal thyroid - usually atrophies and disappears by GA 10w, but portions associated with thyroid tissue may persist at any point between tongue and thyroid

113
Q

epidemiology of thyroglossal duct cysts

A

Most common congenital neck anomaly (70%)
Second most common benign neck mass after lymphademopathy
Usually diagnosed in childhood (up to 40% may present after 20y)

114
Q

Clinical features of thyroglossal duct cyst

A

Midline mass in anterior neck
Moves with swallowing and elevates with tongue protrusion
Often asymptomatic until become infected (red warm painful lump)
Can be diagnosed with USS, CT or MRI

115
Q

Management of thyroglossal duct cyst

A

Excision of cyst and tract

- undergo careful histologic examination as thyroid carcinoma can be present in 1-2%

116
Q

Prevalence of thyroid carcinoma in thyroglossal duct cyst

A

1-2%

117
Q

What is a haemangioma

A

The most common type of vascular tumour occurring almost exclusively in children

118
Q

Natural history of haemangioma

A

Rapid growth phase (first 1-2y) followed by slow regression

Majority will resolve spontaneously

119
Q

Management of haemangioma

A 
Watchful waiting
If symptomatic:
- beta blockers
- systemic glucocorticoids
OR 
- surgical laser excision
120
Q

Management of vascular malformations (HAEMANGIOMA IS A TUMOUR NOT A MALFORMATION)

A

Complete excision, sclerotherapy or laser treatments

121
Q

Apnoea hypopnoea index scores: normal-severe categories

A

Normal: less than 5 events per hour of sleep
Mild: 5-15
Moderate: 15-30
Severe: more than 30 events per hour

122
Q

Definition of apnoea

A

Cessation of oraonasal air flow

123
Q

definition of Obstructive sleep apnoea

A

More than 10 seconds apnoea with respiratory arousal or desaturation due to collapse of airways despite adequate respiratory drive

124
Q

Definition of central sleep apnoea

A

Over 10 seconds of apnoea due to absent respiratory drive from respiratory centre

125
Q

Definition of hypopnoea

A

Less than 50% ventilation for over 10 seconds with respiratory arousal or desaturation

126
Q

Causes of obstructive sleep apnoea in children

A 
Adenotonsillary hypertrophy
Obesity
Long term allergies or hay fever
Medical conditions associated with weak muscles or low muscle tone (e.g. Down syndrome)
Children with flat faces of small jaws
127
Q

Indications for CPAP/BiPAP inc children

A

Children with syndromes or neuromuscular disorders

Refractive OSA post-surgery

128
Q

Normal flora of external auditory canal

A 
Staphylococcus epidermis
Pseudomonas aeruginosa
Staphylococcus aureus
Streptococcus saprophyticum
Candida albicans

Surgery (8 decks)

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