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Y4 Special senses > ENT workbook > Flashcards

ENT workbook Flashcards

1
Q

What assessments/management should be done when a patient presents with a perforated eardrum?

A

Otoscopy
Pure tone audiogram (to asses degree and type of hearing loss)
Keep the ear dry
No more cleaning with cotton ear buds
No eardrops
Review in 4 weeks

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2
Q

What complication are you worried about with chronic otitis media with effusion?

A

Acute mastoiditis

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3
Q

What organisms are commonly involved with chronic otitis media with effusion?

A
  • Staphylococcus aureus
  • Streptococcus pneumoniae
  • Haemophilus influenzae
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4
Q

What important relations of the middle ear/mastoid are at risk during a mastoidectomy?

A

Facial nerve palsy
Sigmoid sinus- bleeding, air embolism
Dura mater- CSF leak or meningitis

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5
Q

What intracranial complications are associated with otitis media?

A
  • Meningitis
  • Intracranial abscess
  • Sigmoid sinus thrombosis
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6
Q

What intra temporal bone complications are associated with otitis media?

A
  • Bacterial labyrinthitis
  • Facial paralysis
  • Petrous apicitis (inflammation of the petrous apex of the temporal bone)
  • Gradenigo syndrome (otorrhoea, retro-orbital pain, lateral rectus palsy)
  • Citelli abscess (abscess in the posterior part of the petrous apex)
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7
Q

Why do you get hearing loss with a cholesteatoma

A
  • Ossicular chain erosion
  • tympanic membrane damage
  • Involvement of the labryinth
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8
Q

What would new onset vertigo after a cholesteatoma surgery indicate?

A
  • Otic capsule erosion- fistula forms between the middle ear and the vestibular system.
  • Abnormal stimulation leads to vertigo and dizziness
  • Pressure changes in the middle ear
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9
Q

Questions to ask in a history of BPPV

A

How long has he had it

How often are episodes

How long do the episodes last

What are the specific triggers

Has he had it before and if so did it resolve spontaneously or require treatment

Any hearing loss or tinnitus associated

Any loss of consciousness with episodes

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10
Q

What recreational drug is commonly implicated in nasal septal defects, and what is its method of damage?

A

Cocaine.
It causes loss of blood supply to the cartilage of the septum

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11
Q

What is the most common type of nystagmus seen in BPPV?

A

Geotropic nystagmus which involves the posterior circular canal
The nystagmus is torsional and upbeating, with the fast phase rotating toward the lowermost ear.

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12
Q

What is functional endoscopic sinus surgery?

A

Uses an endoscope to remove obstructions like polyps, mucosal swellings or infected tissue.

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13
Q

What are the potential complications of sinus surgery?

A

Bleeding, infection, CSF leak, visual loss or disturbance.

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14
Q

What are the steps to control a posterior epistaxis?

A

Look at the posterior wall of the oropharynx by shining a light in the mouth and using a tongue depressor.

If there is fresh blood running down the wall he will require removal of the anterior packing and either a post nasal pack or a nasopharyngeal balloon followed by further anterior nasal packing

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15
Q

Where does posterior epistaxis arise from?

A

Branches of the sphenopalatine artery
This supplies the posterior nasal cavity
The bleeding may involve the posterior ethmoidal artery

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16
Q

How is posterior packing inserted?

A
  • Using local or general anaesthetic
  • The balloon catheter is inserted and gently advanced until it reaches the choanae (the opening between the nasal cavity and the nasopharynx)
  • The pack is inflated to apply pressure
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17
Q

How would you manage a patient with posterior epistaxis if packing and cautery of the bleeding vessels were to fail?

A

He would require a general anaesthetic either to pack more effectively or to cauterise the bleeding point or ligation of the sphenopalatine artery and possibly the anterior ethmoidal artery.

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18
Q

What are the complications of submandibular surgery?

A

Bleeding infection, damage to the lingual or hypoglossal nerves or cervical branch of the facial nerve.

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19
Q

Anatomically where is the hypoglossal nerve in relation to the submandibular gland?

A

Lies deep

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20
Q

Anatomically where is the facial nerve in relation to the submandibular gland?

A

The cervical branch of the facial nerve runs superficial to the gland and can be damaged in a high skin/platysma incision.

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21
Q

An 80-year old man is referred with a left sided mass anterior to the ear. He complains of drooling, and his face is drooping on the left. He has several hard lymph nodes in his neck on examination.

What salivary gland is likely to be affected?

A

Parotid

The parotid gland is located anterior to the ear and extends to the area over the mandible

The facial nerve passes through the parotid (facial drooping)

Hard lymph nodes indicate a malignancy

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22
Q

What is Frey’s syndrome?

A
23
Q

Why is facial nerve involvement indicative of parotid gland malignancy?

A

Malignant tumors (mucoepidermoid, adenoid cystic carcinoma and acinic cell carcinoma) grow infiltratively

Tumours that grow rapidly or involve the deep lobe of the parotid gland are more likely to involve the facial nerve

24
Q

When performing a neck dissection, what important structure in the posterior triangle is at risk of damage? If damaged, how might this affect the patient?

A

Accessory nerve
Shoulder drop

25
Q

What is Frey’s syndrome?

A

Damage to the auricolutemporal nerve (innervates the parotid gland to produce saliva)

Undergoes aberrant nerve regeneration

Innervates the sweat glands of the skin instead

You get sweating and flushing of the skin

26
Q

Difference in the risks between doing thyroid surgery on a patient who is hyperthyroid vs euthyroid.

A

Hyperthyroid= Thyrotoxic storm and a higher risk of bleeding.

Euthyroid= Bleeding, infection, injury to the recurrent laryngeal nerves, hypothyroidism, hypoparathyroidism

27
Q

Describe the course of the recurrent laryngeal nerve on the left and the right

A

Both the left and right recurrent laryngeal nerves branch off of the vagus nerve

Left
- Loops underneath the aortic arch
- Then travels upwards to the larynx

Right
- Loops underneath the right subclavian artery
- Travels upwards to the larynx, simliar to the left but the right is shorter

28
Q

What is the most important blood test to check after a routine total thyroidectomy and what symptoms would suggest that this blood test was going to be low?

A

Calcium.
Tingling around mouth and fingertips. If severely decreased muscle spasm occurs.

29
Q

What ear drops are used in otitis externa?

A

Gentamicin

30
Q

What lines the middle ear?

A

Pseudostratified columnar epithelium

31
Q

Common pathogens in the middle ear

A

Common pathogens include Streptococcus pneumoniae, Haemophilus influenzae and Moraxella species.

Similar to the lungs! Think of the middle ear as continuation of the upper respiratory tract

32
Q

Risks of mastoid surgery

A
  • Small risk of facial nerve palsy
  • Altered taste from damage to the chorda tympani
  • CSF leak
  • Tinnitus
  • Vertigo
  • Complete hearing loss of the operated ear
33
Q

What time frame will most cases of otitis media resolve in?

A

3 months

34
Q

What is the pathophysiology behind otosclerosis?

A

Mature bone is gradually replaced with woven bone

Symptoms develop as the stapes footplate becomes fixed to the oval window

35
Q

Investigations for otosclerosis

A

Tympanogram- normal type A trace

Pure tone audiogram- conductive hearing loss
Carhart notch at 2kHz

36
Q

Management for otosclerosis

A

Conservative- hearing aid
Surgery- stapedectomy

37
Q

What is the management of Meniere’s disease

A

Dietary- reduce salt, chocolate, alcohol, caffeine and chinese food

Medical
- Thiazide diuretics
- Betahistine
- Vestibular sedatives- prochlorperazine for acute attacks only

Surgical
- Grommet insertion
- Dexamethasone middle ear injections
- Endolymphatic sac decompression
- Vestibular destruction using middle ear injection of gentamicin
- Surgical labryinthectomy- very rare

38
Q

Cautery management of epistaxis

A

Cautery – silver nitrate or bipolar diathermy
 If anterior bleed – with anterior rhinoscopy
 If posterior bleed – with rigid endoscope

39
Q

Explain the surgical/radiological management of epistaxis

A

If nasal packing fails to stop the bleeding the following vessels can either be ligated surgically or embolised radiologically
 Sphenopalatine
 Anterior ethmoid (can not be embolised because comes from internal carotid artery)
 External carotid (last resort)

40
Q

When would you manipulate a nose after nasal trauma?

A

If deviated nose consider Manipulation under anaesthetic (LA/GA) within 2 weeks of injury

41
Q

What are some complications of surgery involving the sinuses?

A
  • Damage to the orbit- the orbit lies lateral to the ethmoid sinus and superior to the maxillary sinus
  • Anterior skull base- lies just above the sphenoid and ethmoid sinuses and can be breached during surgery which can cause a CSF leak and in the worst cases brain injury
42
Q

What is the common cold normally caused by?

A

Rhinovirus and influenza virus

43
Q

What is non-viral ARS?

A

Non-viral ARS is considered to be the persistence of symptoms after 5 days, caused mainly by super added bacterial infections such as Streptococcus pneumoniae, Haemophilusinfluenzae, and Moraxella catarrhalis.

44
Q

What are clinical features of Ludwig’s angina?

A
  • Swelling of the floor of the mouth
  • Painful mouth
  • Protruding tongue
  • Airway compromise
  • Drooling
45
Q

Investigations for Ludwig’s angina

A
  • CT neck
  • OPG (An OPG (Orthopantomogram) is a specialized dental X-ray that provides a panoramic view of the mouth, including the teeth, jaws, and surrounding structures. It is commonly used in dentistry and maxillofacial diagnostics.)
46
Q

Most common cause of obstructive sleep apnoea in children

A

Adenotonsillar hypertrophy

47
Q

Investigations for obstructive sleep apnoea

A
  • BMI
  • TFT- hypothyroidism
  • CXR- signs of obstructive lung disease
  • ECG- signs of right ventricular failure
48
Q

Treatment for obstructive sleep apnoea

A
  • Advice and lifestyle changes including weight loss
  • CPAP
  • Mandibular positioning devices
  • Adenotonsillectomy in children
49
Q

Investigations for a primary tumour site of a H&N cancer

A
  • Panendoscopy or laryngopharyngo-oesophagoscopy (biopsy for histology and size)
  • CT neck- assess size of tumour and neck node metastasis
50
Q

Investigation for a neck lump

A

FNA with ultrasound
Assumed that any palpable cervical lymphadenopathy is secondary to a primary tumour if found

51
Q

What thyroid cancer has a preponderance to metastasis to the bones and lungs?

A

Follicular carcinoma

52
Q

What is the management for follicular, papillary or medullary carcinoma of the thyroid?

A

Total thyroidectomy
Anaplastic disease is normally too far advanced for curative surgery

Radio-iodine therapy for papillary and follicular carcinoma after surgery

53
Q

What are complications of thyroid surgery?

A
  • Post-operative haemorrhage
  • Airway obstruction secondary to haemorrhage or bilateral vocal cord palsy
  • Vocal cord palsy
  • Hypocalcaemia

Y4 Special senses (8 decks)

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