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Surgery Y6 > ENT > Flashcards

ENT Flashcards

1
Q

Summarise the epidemiology of epiglottitis

A

Classically: 2-4y However, HiB vaccination means it is presenting more often in adults

(NICE)

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2
Q

Define epiglottitis

A

Rapidly progressive cellulitis of the epiglottis, usually due to infection with haemophilus influenza B (HiB)

In adults, it is called supraglottitis

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3
Q

Summarise the prognosis for patients with epiglottitis

A

Mortality: adults <3%, children <1%

(UpToDate)

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4
Q

Recognise the presenting symptoms of epiglottitis

A

Fever, hoarse ‘hot potato’ voice, inspiratory stridor, toxic, drooling, tripod position, painful swallowing

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5
Q

Identify the possible complications of epiglottitis

A
  • Upper airway obstruction
  • Epiglottic abscess
  • Necrotizing epiglottis
  • Secondary infection
  • Death

(UpToDate)

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6
Q

Generate a management plan for epiglottitis in the community

A

If ? epiglottitis in GP, call 999 immediately. Important not to upset child as there is risk of upper airway obstruction so do not examine throat, only ‘waft’ O2 at them

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7
Q

Generate a management plan for epiglottitis in A&E

A
  • Medical (ABCDE):
    • Call for help: anaethetic, ITU, ENT
    • A: intubation may be necessary (anaesthetist ideally, with surgeon ready for surgical airway)
    • IV antibiotics (3rd gen cef)
    • Nebulized adrenaline (1:1000): under consultant guidance
    • PO steroids (dexamethasone /6h)
    • Analgesia

(BMJ)

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8
Q

Summarise the indications for a tracheostomy

A

1) emergency: to secure a definitive airway in upper airway obstruction
2) elective: to wean a pt off ventilation

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9
Q

Identify the possible complications of a tracheostomy

A
  • Acute
    • Obstruction: by the membranous posterior trachea wall
    • Subcutaneous emphysema
    • Pneumothorax
  • Chronic
    • Tracheal stenosis
    • Tracheoarterial fistula
    • Loss of phonation

(UpToDate)

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10
Q

Epistaxis: 90% of cases involve bleeding from what area? What is the vascular supply?

A

Little’s area (aka Kiesselbach’s triangle, anterioinferior nasal septum)

  • Anterior ethmoidal artery
  • Sphenopalatine artery
  • Greater palatine artery
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11
Q

Epistaxis: management

A

In commmunity

  • Head forward, external compression, spit out blood
  • Call 999 after 10 mins if old/anticoagulated. 25 mins if young/well

In A&E

  • Packing (provides internal pressure to tamponade bleed). Either
    • Merocel (nasal tampon) - lubricate before
    • Rapid Rhino - can be deflated so removed with less trauma. Keep in for 24-72h (no longer as risk toxic shock syndrome and pressure necrosis of nasal folds)
  • If bleeding stops on pressure:
    • identify bleeding point (using thudicum)
    • cauterize - silver nitrate (LA + adrenaline before)
  • If bleeding does no stop on pressure:
    • surgery: shenopalatine artery (SPA) ligation
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12
Q

Epistaxis: causes

A

Common:

  • Trauma
  • Infection
  • Anticoagulation

DDx:

  • Angiofibroma
  • Nasopharyngeal carcinoma (>50y)
  • Leukaemia (<2y, acute lymphoblastic)
  • Hereditary haemorrhagic telangiectasia
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13
Q

Epistaxis: red flags

A
  • Age <2y or >50y
  • Nasal obstruction
  • Facial pain
  • Hearing loss
  • Proptosis
  • Diplopia
  • Lymphadenopathy
  • Wt loss
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14
Q

What are the complications of a surgical mastoidectomy?

A
  • Conductive hearing loss
  • Meningitis
  • Venous sinus thrombosis
  • Cerebral abscess
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15
Q

What test on examination idetifies benign positional paroxysmal vertigo?

A

Dix-Hallpike test (O/E): hyperextend neck and then move to side. Look in eye for nystagmus. +ve in BPPV

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16
Q

Recognise the presenting symptoms of Meniere’s disease

A

Triad:

hearing loss / tinnitus

vertigo

sensation of fullness in the ear

Episodic, usually unilateral

17
Q

Generate a management plan for Meniere’s disease

A
  • Conservative: low salt diet
  • Medical:
    • Diuretics
    • Intratympanic gentamicin (kills ear, so only used after severe hearing loss to stop vertigo)
  • Surgical
    • Decompression of semicircular canals
18
Q

Identify the possible complications of Meniere’s disease

A

Profound hearing loss

Falls

19
Q

Summarise the prognosis for patients with Meniere’s disease

A

Slowly progressive, but with periods of remission

20
Q

Summarise the epidemiology of acoustic neuroma

A

1 / 100 000 incidence

3:2 F:M

21
Q

Define acoustic neuroma

A

benign, slow growing tumour extending from the vestibulocochlear nerve, extending into the cerebellopontine angle

aka. vestibular schwannoma
* (BMJ)*

22
Q

Recognise the presenting symptoms of acoustic neuroma

A

Asymmetrical hearing loss (tinnitus, difficulty localising sounds)

Facial numbness

Progressive episodes of dizziness

(BMJ)

23
Q

Identify the possible complications of acoustic neuroma

A

Compression:

Facial nerve palsy

Brainstem –> blown pupil (III CN compression) –> death

Surgical: infection, stroke, VII CN damage

24
Q

What are the indications for tonsillectomy?

A

Indications for tonsillectomy:

  • meets all of these criteria
    • sore throats are due to tonsillitis
    • 5+ episodes of sore throat /y
    • sx occuring for at least 1y
    • episodes of sore throat are disabling (prevent normal functioning)
  • recurrent febrile convulsions secondary to tonsillitis
  • obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils
  • peritonsilar abscess (quinsy), if unresponsive to standard tx

(Passmedicine, NICE)

25
Q

Define cholesteatoma

A

A cholesteatoma consists of squamous epithelium that is ‘trapped’ within the skull base causing local destruction. It is most common in patients aged 10-20 years.

(passmedicine)

26
Q

What are the main features of cholesteatoma

A

Main features

  • foul smelling discharge
  • hearing loss

Other features are determined by local invasion:

  • vertigo
  • facial nerve palsy
  • cerebellopontine angle syndrome

‘Attic crust’ on otoscopy

(passmedicine)

Surgery Y6 (7 decks)

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