ENT Flashcards
what is a cystic hygroma and where might you find it
cystic lymphangioma, congenital lymphatic lesion, usually found in armpits or left posterior triangle
-most are evident at birth
what is a branchial cyst and where might you find it?
it is a large mobile mass between the sternocleidomastoid muscle and the pharynx
Develop due to failure of obliteration of the second branchial cleft in embryonic development
Usually present in early adulthood
borders of the anterior triangle in the neck
medial side sternocleidomastoid
imaginary mid line
mandible
borders of the posterior triangle in the neck
lateral side sternocleidomastoid
middle 1/3 clavicle
trapezius muscle
what is FESS
functional endoscopic sinus surgery
drains the paranasal sinuses
in chronic sinusitis or polyposis
if patient is having a massive nose bleed what should you do?
-FBC- coagulation screen
-group and save
anterior nasal packing, posterior nasal packing if continued
-admit to the ENT ward
-consider ligation of blood vessel
whats the area of the nose called that is most prone to bleeding
Little’s area
what blood vessels make up littles area
- anterior ethmoid
- sphenopalatine
- greater palatine
what should you advise a patient with epistaxis
avoid hot drinks, hot baths and showers, picking nose, hot and spicy foods
what should you do if a patient on warfarin has a nosebleed
omit the warfarin for 24 hours and discuss with a senior
common organism to infect the nose`
staph A
malignancy in chinese to cause nosebleeding
postnasal space nasopharyngeal carcinoma squamous cell carcinoma
Lymphoma neck lump characteristics
rubbery, painless swelling, becomes tender with alcohol, patient may also report night sweats and fever
splenomegaly may be associated also
presenting features of nasopharyngeal carcinoma
unilateral otalgia, serous otitis media, epistaxis, feeling of blockage in the nose, hard cervical lymphadenopathy, cranial nerve palsies 3-6
tmt nasopharyngeal carcinoma
radiotherapy
nasopharyngeal carcinoma is associated with which virus?
EBV
fun fact! also associated with nickel exposure!ask if they worked in furniture manufacture
symptoms of rhinosinusitis
-nasal blockage
-discharge
+/-
-loss of sense of smell
-facial pain/pressure
may be associated with nasal polyposis
how many weeks must rhinosinusitis be going on for to be considered chronic
12
how would you investigate rhinosinusitis
anterior rhinoscopy nasendoscopy RAST testing - to find allergens IgE testing- to look for allergic causes cANCA- to rule out GPA ACE- to rule out sarcoidosis CT SCAN
ddx rhinosinusitis
tension headache
migranous headache
atypical facial pain
tmt of rhinosinusitis
steroid sprays, antihistamine sprays , systemic steroids, macrolide antibiotics (erythromycin, clarythromycin)
then FESS
FESS info, complication
surgery through the nose, to clear out the infective content , may clear small bits of bone and skin/polyps, there are no scars to the face
uncommon
patient may have some orbital bruising
bleeding risk, risk of csf leak, risk of infection
common
mild pain , treatable with simple analgesia
