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ENT stuff Flashcards

1
Q

Meniere Triad

A

Tinnitus,sensorineural Hearing loss and Vertigo

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2
Q

ENT signs of head trauma

A

CSF otorrhea
CSF rhinorrhea
Hemotympanium
Battle sign
Raccoon eyes sign

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3
Q

Tragus sign(putting pressure on the tragus) is a sign of?

A

Otitis externa or otitis media

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4
Q

Mx of otitis externa

A

Pain relief:acetaminophen, ibuprofen, heat or cold pakcs, codeine(IF severe)

Definitive:
-uncomplicated OE: Floroquinolone ear drops+- polymyxin B +-bacitracin
- complicated OE: Oral Abx

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5
Q

What constitutes complicated otitis externa

A

Acute Otitis media
Lymphadenitis
Facial cellulitis
Immunocompromised pt at risk of malignang otitis externa

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6
Q

Complications of malignant otitis externa

A

Bacterial labyrinthitis
Mastoiditis
Cerebral abscesses

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7
Q

What can cause paediatric pt to pull on the ear

A

Otalgia, pruritus, fullness

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8
Q

Types of ear discharge

A

Ear wax
Ear drops
Purulent
Bloody
Clear,possibly CSF

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9
Q

Giving ear drops in child below vs above 3yo

A

Below:pull pinna down and back
Above:pull pinna up and back

Then leave in lying position for 3-5mins

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10
Q

Causes of mouth ulcers

A

Trauma eg falls
Infection eg HFMD/coxsackie, herpangina
Apthous ulcer
Rarely SLE or IBD

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11
Q

Causes of enlarged lymph nodes

A

Infected due to bacteria
Reactive due to viral, bacterial infection
Inflammatory eg kawasaki disease
Malignancy:leukemia,lymphoma

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12
Q

Causes of a groin rash in a child

A

Contact dermatitis(nappy rash)
Candidiasis

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13
Q

Complications of BCG intradermal injection

A

Bleeding
Keloid
Infection and abscess

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14
Q

Mx of nappy rash

A

Air dry, barrier cream, wash and keep clean

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15
Q

Site of BCG injection

A

Left deltoid, left buttock

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16
Q

Mx of skin candidiasis infection

A

Miconazole
Cotrimazole
Nystatin

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17
Q

When is enuresis abnormal?

A

Most are toilet trained by 5, some may have enuresis after 7 but treat then with patience and do not shame them

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18
Q

Causes of enuresis

A

1.Deep sleepers who don’t respond to full bladder
2.lack of ADH

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19
Q

Enuresis mx

A

1.Lifestyle changes wrt to fluid intake and passing urine
2. Bladder training
3. Moisture alarms
4. Medications if serious

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20
Q

Red flags for secondary enuresis

A
  1. Wetting bed after already being dry
  2. Hematuria
  3. Dysuria
  4. Polydipsia: Diabetes insipidus
  5. Day incontinence
  6. Constipation
  7. Weakness,abnormal sensation in legs(spina bifida,CES)
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21
Q

Scoring for OSA

A

STOP BANG

Snoring
Tiredness
Observed apnoeas
Pressure high(blood)

BMI >35
Age >50
Neck circumference >40cm
Male gender

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22
Q

Gold standard for OSA dx

A

Sleep study, standard polysomnography

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23
Q

What is the PALM scale

A

Causes of OSA

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24
Q

Score for predicting thyoid storm

A

Burch wartofsky score

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25
Q

Location of tracheostomy

A

Between 2nd and 3rd tracheal rings, 2-3 finger breadths above sternal notch

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26
Q

Parotidectomy scar nameq

A

Modified Blair incision

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27
Q

Vestibular suppresant example

A

Betahistine, can be given for any case of vertigo

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28
Q

Broad causes of hoarseness

A

Infectious
Inflammatory
Neoplastic
Others

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29
Q

Speech rehab options post total larnygectomy

A
  1. Esophageal speech
  2. Electrolarynx
  3. Voice prosthesis
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30
Q

Treatments for larnygeal cancer

A
  1. Trans other laser resection
  2. Open:partial or total laryngectomy
  3. Non surg: RT or chemo RT
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31
Q

Types of neoplastic causes of hoarseness

A

Vocal cord Nodule, cyst or polyp
Maligancy:SCC,Adenocarcinoma or sarcoma

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32
Q

Causes of vocal cord paralysis

A

Idiopathic
Iatrogenic: Intubation, thyroid or thoracic surgery
Infectious: Viral
Neoplastic: Thyroid, esophageal, lung
Traumatic: blunt or deep neck lacerations

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33
Q

Differing course of recurrent laryngeal nerve

A

Left goes under aortic arch
Right under SCA

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34
Q

Indications for tracheostomy

A
  1. Prolonged ventilation
  2. Airway protection
  3. Airway obstruction
  4. Tracheobronchial toilet
  5. Surgical access
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35
Q

Intra op complications of tracheostomy

A
  1. GA related
  2. Airway fire
  3. Injury to surrounding structures
  4. Bleeding
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36
Q

Post op cx of tracheostomy

A

Early
-air leak syndromes
-infection
-bleeding
-obstruction/decannation

Late
-tracheal stenosis
-tracheal fistulas

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37
Q

Types of tracheostomy

A

Cuffed vs non cuffed
Fenestrated vs non fenestrated
Single vs double lumen
Adjustable flange

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38
Q

Indications for cuffed tracheostomy

A
  1. Positive pressure ventilation
  2. Aspiration risk
  3. Bleeding risk
  4. Unstable pt
  5. New trachoestomy
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39
Q

Fenestrated tracheostomy indications

A
  1. Spigotting
  2. Phonation rehab
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40
Q

Single lumen vs double lumen tracheostomy

A

Single in paeds and better for ventilation

Double better for toileting

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41
Q

Indications for adjustable flange tracheostomy

A

Difficult anatomy eg thick neck, deep trachea

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42
Q

Frequency of tracheostomy tube change

A

Single lumen /1-2 weeks
Double lumen /1-3months

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43
Q

3 principles of thyroid mass Mx

A

1 Imaging: US
1 Blood test TFT
1 biopsy FNAC

44
Q

Cx of an untreated pinna hematoma

A
  1. Cauliflower ear
  2. Pinna abscess
45
Q

WHat is microtia

A

Underdevelopment/ dysplasia of the pinna

46
Q

Risk factors for microtia

A

Teratoma

Syndromes
1. Digeroge/ cardio-velo-facial
2. Branchio-oto-renal
3. Treacher Collins
4. Goldenhar

47
Q

Mx of microtia

A

Atresiaplasty and cosmetic autologous reconstruction

48
Q

What is malignant otitis externa

A

Temporal bone osteomyelitis

49
Q

Invx in a case of malingnant otitis externa

A

Biochemical
1. FBC
2. RP
3. CRP/ESR
4. Swab and blood culture+sensitivity

Imaging
1. CT temporal bone
2. MRI skull base

Proecdural
1. Biopsy tro SCC

50
Q

Mx of Malignant Otitis Externa

A
  1. Admission for IV Abx: Piptazo , ciprofloxacin or ceftazidime
51
Q

Common causative pathogens for malignant otitis externa

A

Psuedomonas, then S Aureus then fungi

52
Q

Cx of malignant otitis externa

A
  1. Mastoiditis
  2. Bacterial Labyrinthitis
  3. Intracranial abscess with CN deficits
53
Q

Cause of swelling and erythema of the pinna sparing the lobule

A

Perichondritis

54
Q

Perichondritis Mx

A

Admit for IV piptazo, I&D

55
Q

Cx of perichondritis

A
  1. Cauliflower ear
  2. Facial cellulitis
56
Q

Causes of cauliflower ear

A
  1. Trauma
  2. Infection: Pinna abscess or perichondritis
57
Q

Associated injuries in a hemotympanium

A
  1. Ossicular chain disruption
  2. base of skull fx
  3. Mastoid fx
  4. Labyrinthine concussion
  5. Labyrinthine fistula
  6. CN7 palsy( chorda tympani injury)
  7. Carotid artery injury
  8. TM perforation
58
Q

Mx of hemotypanium

A
  1. TRO CN7 palsy and comorbid traumatic injury
  2. If hearing loss does no resolve in 3/12 and HL >30db, do CT temporal bone tro ossicular chain disruption
59
Q

Mx of Ramsay Hunt Syndrome

A

Prednisolone, antivirals(acyclovir?), omeprazole. topical eye drops

60
Q

Cx of Ramsay Hunt

A
  1. Ear infections eg cellulitis, perichondritis
  2. Corneal ulcer from exposure keratopathy
61
Q

Invx for cholesteatoma

A
  1. CT Temporal bone
  2. Audiometry
62
Q

Mx for cholesteatoma

A

Tympanomastoidectomy and ossicular chain reconstruction if indicated

63
Q

Cx of cholesteatoma

A
  1. Labyrinthitis
  2. Meningitis, abscess, empyema
  3. HL from ossicular chain dysruption
  4. CN 7 palsy
  5. Mastoiditis
64
Q

How to tell if otoscopy shows L or R ear

A

Cone of light points to direction of that ear

65
Q

Invx of case of Otitis Media with effusion

A
  1. Audiometry
  2. Tympanogram
  3. Nasoendoscopy
66
Q

Cx of otitis media with effusion

A
  1. Mastoiditis
  2. Meningitis
67
Q

Mx of otitis media with effusion

A
  1. Abx
  2. TRO NPC
  3. Grommet tube placement if does not resolve in 3/12
  4. Early grommet placement if child with language delay
68
Q

invx for TM perf from CSOM

A
  1. Tympanogram
  2. Audiometry

CT TB NOT needed

69
Q

Mx of TM perf rom CSOM

A
  1. Myringo/tympanoplasty if deos not get better
  2. Aural toilet and abx if infected
70
Q

Risk factors for otosclerosis

A
  1. MIddle Aged
  2. Female
  3. Indian or caucasian
  4. Lack of fluoride
  5. FMHX strongest indicator
  6. Genetic
  7. Autoimmune predilection
71
Q

Invx for suspected Otosclerosis

A

CT/MRI temporal bone tro other causes eg ossicular chain disruption, mass

72
Q

mx of otosclerosis

A
  1. Do nothing
  2. Hearing aids
  3. Exploratory tympanotomy with stapedotomy nad prosthesis
73
Q

Mx of cerebellopontine tumor eg Acoustic Neuroma/Vestibular schwannoma or meningioma

A

Surgery +- RT

74
Q

Tests for suspected Labyrinthitis

A

Audiometry and MRI IAM

75
Q

Mx of sshl/sUDDEN SENSORINEURAL HEARING LOSS

A
  1. PO prednisolone
  2. Omeprazole
  3. Hyperbaric O2 therapy
  4. audiometry and IT dexamethasone if no improvement in 2/52
76
Q

Olfactory tests

A
  1. Upsit test
  2. Sniffing sticks
77
Q

what is FESS

A

Functional endoscopic sinus surgery

78
Q

Sx of OSA in children

A
  1. Restlessness
  2. Abnormal sleeping posture
  3. Laboured breathing
  4. Paradoxical breathing
  5. Nocturnal enuresis
  6. Abnormal limb movements
79
Q

What is AHI in OSA context

A

Apnea Hypopnea Index

80
Q

ADHI severity for kids

A

1-5 mild
5-10 moderate
10< severe

81
Q

First line surgical mx for child with OSA

A

Tonsillectomy and adenoidectomy

82
Q

Most impt muscle related to a ranula

A

Myelohyoid dy/dx plunging and normal ranula

83
Q

Mx of torus palate

A

Reassure and obsevration

84
Q

Sx of SCC of the tongue

A

Tongue mass
Bleeding
Pain
Speech and mastication difficulties
Neck swelling

85
Q

Risk factors for Oral/ tongue SCC

A

Smoking
Scalding water
Sharp Teeth
Sunlight
Substances eg betel nut

Immunosuppression
Radiation exposure
Prev Ca/dysplasia

86
Q

Mx of tongue SCC

A

Wide local excision with neck dissection +- adjuvant RT

87
Q

Cx of wide local excision of tongue SCC`

A

Neck aspiration of saliva
Bleeding
Problems with speech and swallowing

88
Q

Invx, Mx and Cx of nasal dermoid

A

Invx: CT/MRI brain/sinus for intracranial extension

Mx: Complete surgical excision

Cx: CSF leak, Meningitis and deformity

89
Q

Tests for CSF rhinorrhea/ otorrhea

A

Bedside: Looking for halo sign on gauze

Electrophoresis for beta 2 transferrin

90
Q

Mx of Base of skull fracture

A

Surgical repair

Conservative: Head elevation, stool softeners, acetazolamide, lumbar drain, observe for 7 days

91
Q

Contraindications to skin prick testing

A
  1. Young child
  2. Pregnancy
  3. Severe uncontrolled asthma
  4. Severe allergic rxns/ anaphylaxis
92
Q

What is Chandler’s classification for

A

Orbital cellulitis and its Cx

93
Q

XR signs of button battery in child’s nose

A

Stab sign on lateral skull XR
Halo sign on AP Skull XR

94
Q

Cx of button battery in nose

A

Nasal septum perforation
Septal infection and abscess
Crusting and bleeding

95
Q

Sx of Nasopharyngeal carcinoma

A

Blood in Sputum
LOA,LOW
Unilateral hearing Loss and otalgia due to OME
Unilateral nasal obstruction
Neck lumps

96
Q

Invx for NPC

A

Biopsy via nasoendoscopy to confirm

MRI nasopharynx
PET CT

97
Q

Most important risk factor for NPC

A

EBV infection

98
Q

Mx of NPC

A

RT+- chemo
Surgery and neck dissection for recurrent local disease

99
Q

Cx of NPC Mx

A

1.Risk of Carotid blowout
2 Vocal cord paralysis and bovine cough
3 Trismus( TMJ rigidity)
4 Neck muscle stiffness
5 Sinusitis
6 Atrophic rhinitis
7 CN palsy
8 Hearing loss, OME
9 Hypopituitarism
10 Secondary cancers
11 Dry mouth

100
Q

Causes of laryngeal paillomatosis

A

HPV 6 and 11

101
Q

Mx of laryngeal papillomatosis

A
  1. Laser
  2. Microdebrider
  3. Cold steel surgery
  4. anti VEGF injection
  5. HPV vaccination
  6. Systemic interferon therapy
102
Q

Treatment for facial haemangiomas

A

PO propanolol

103
Q

Syndrome associated with facial haemangiomas and main concern

A

PHACE(Pastrual Castroviejo), worried about subglottic airway haemangiomas

104
Q

XR sign of acute epiglottitis

A

Thumb sign

105
Q

ausative agent of epiglottitis

A

Haemophilus Influenzae B

106
Q

Mx of epiglottitis

A

Secure airway
Send to ot ,intubation, if fail tracheostomy, cricothyroidotomy?
Telescope to railroad in larynx
Iv Abx, steroids, rescope for interval improvement,
Ct if persistent swelling tro abscess
Determine if patient requires hospitalisation
Stabilise the patient

107
Q

Syndrome associated with medullary thyroid cancer

A

Multiple Endocrine Neoplasia Type 2(MEN 2)

M4 Stuff (11 decks)

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