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ENT > general notes > Flashcards

general notes Flashcards

1
Q

What is an acoustic neuroma?

A

it’s a vestibuloschwannoma : a tumour of schwann cells surrounding CNVIII

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2
Q

Functions of CNVII

A

facial expression
the chordae tymphani innervates the anterior 2/3 of the tongue
stapedius: innervates the stapedius muscle that controls the stapes in relation to the round window

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3
Q

Routes of CNVII

A

IAM, middle ear, stylomastoid foramen and parotid gland

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4
Q

Branches of CNVII

A 
Temporal
Zygomatic 
Buccal
Marginal Mandible
Cervical
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5
Q

Parts of the temporal bone

A

Temporal
Zygomatic
Petrous
Mastoid

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6
Q

Give symptoms and treatment for pharyngeal pouch

A

dysphagia and bad breath, regurgitation of food, globus

this is a weakness of the inferior and middle constrictor muscles of the pharyngeal muscle region
At killian’s dehiscence it tends to occur
Treatment is surgical excision with staples

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7
Q

Patient comes in with a sore throat, what are you differentials?

A

tonsilitis
glandular fever
laryngitis
epiglottis/ supraglottitis

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8
Q

What are the red flag symptoms you should be asking for in a hx for neck swelling?

A

night sweats
anorexia and weight loss
rash
malaise

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9
Q

Tonsilitis: causative organism and medication choice

A

group A beta haemolytic strep

PO Ben V not amoxicillin or ampicillin

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10
Q

Tonsillectomy bleeding

A

within 24 hours, go back to theatre

3-10 days plus associated fever, poor fluid intake: consider IV ABX

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11
Q

Tonsilitis patient coughs, does this harm your diagnosis?

What questions do you need to ascertain that it’s not glandular fever? THis includes addressing upon examination

A

yes, absence of cough indicates tonsilitis

Have you ever had tonsilitis?
Lumps, swelling elsewhere? (generalised lymphadenopathy)
Abdo pain
Prodromal illness

Hepatomegaly

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12
Q

Ix for glandular fever?

A

FBC and blood film, LFTs
monospot test
Paul Bunnell test: sheep RBCs that clump or aggregate when they are put in blood samples of patients with heterophile antibodies

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13
Q

For how long is glandular fever transmissable?

A

6 weeks (during this time no contact sports or heavy lifting

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14
Q

How does a quinsy present? How do you manage a quinsy?

A 
dysphagia
referred ear pain 
trismus (give analgesia and local anaesthetic)
hot potato voice
spitting out saliva

deviated uvela

IV ABX, fluids
Incision and drainage/ tonsillectomy
analgesia

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15
Q

causative organism of quinsy?

A

strep pyogenes or h-influenzae or anaerobes

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16
Q

red flag questions or signs for a pharyngeal neck infection?

A 
drooling
restricted neck movements
high fever/septic
can't breath
displaced pharynx
tongue swelling
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17
Q

who gets retropharyngeal abscesses?

A

50% of the time it’s children between 6-12 months of age, 96% of the time it’s those below 6 y/o

18
Q

aetiology of a pharyngeal space infection

A 
tonsils
parotid gland
nasopharynx
odontogentic 
pharynx
19
Q

aetiology of a pharyngeal space infection

A

adenitis suppuration (rouviere’s nodes)
trauma
foreign body

20
Q

Ludwig’s angina presentation?

A

submandibular or sublingual swelling
woody induration
history of dental issues (pericoronitis)/ immunocompromised
cellulitis
bilateral
hot potato voice
difficulty breathing (floor of mouth effectively pushed up)

21
Q

Complications of DSNI?

A

carotid artery erosion (ICA-ECA- CCA)
mediastinitis
lemierre’s disease
rupture: lung abscess, pneumonia, empyema

22
Q

Rare systemic complications of EBV?

A

CN palsies, Guillian Barre syndrome

23
Q

Other viral diseases that can present like EBV?

A

HSV-1, CMV, HZV, hand foot and mouth disease

24
Q

What other conditions do clinicans need to be alert to, particularly in developing countries?

A

HIV, TB, syphillis, diptheria

25
Q

Which drug should you avoid in children with sore throats?

A

Aspirin: risk of reyes syndrome

26
Q

Where exactly do quinsies occur?

A

Between the fibrous layer of the tonsil and the superior pharyngeal constrictor muscle

27
Q

ddx to quinsy?

A

peritonsilar cellulitis (CT/Uss)

28
Q

How would you diagnose a quinsy?

A

Clinical–> aspiration of pus

If not clear, CT or Uss

29
Q

How do you manage a quinsy?

A

Admit
IV fluids, IV BenPen (+ metronidazole). Gives good anaerobe coverage plus for strep. Alternatively give erythromycin
If abscess present drainage
tonsillectomy might be appropriate

30
Q

Potential complication of a quinsy?

A

mediastinitis, DSNI

particularly IC, diabetics

31
Q

Sources of infection for a parapharyngeal abscess?

Common organisms?

A

Peritonsillar, submandibular, retropharyngeal space
Dental infections, tonsil infections
Gram negatives- klebsiella

32
Q

What do you do if you suspect a PP abscess?

A

CT H,N, C

33
Q

What is a retropharyngeal abscess? Causative organism?

A

Common in children between 3-5, following URTI. It’s a suppurative infection of the retropharyngeal LNs

Often Strep Viridans

34
Q

How do children with a RP tend to present? How should you respond?

A

Fever, stiff neck, irritability, dysphagia and noisy breathing

Exclude epiglottis (haemophilis influenzae vaccine?)
X-ray/ CT
35
Q

ddx for RP abscess in adults?

A

nasopharyngeal cancer, carotid anuerysm, lipoma

36
Q

management of RP abscess

A

CT
Drainage
IV ABX
be careful with airway intubation due to risk of perforating abscess

37
Q

Dangerous sore throat red flag symptoms that require urgent referral to ENT?

A 
Smoker/Stridor
Consistent hoarse voice/ Coughing up blood
Acute onset not related to URTI/ Alcohol
Loss of weight
Dysphagia/Dyspnea
38
Q

potential complications of tonsilitis?

A

quinsy
otitis media
rheumatic fever
glomerularnephritis

39
Q

How long until you consider surgery for a quinsy?

A

6 weeks, generally speaking

40
Q

True or false: sinusitis presents with a cough?

A

True

ENT (3 decks)

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