general notes Flashcards
What is an acoustic neuroma?
it’s a vestibuloschwannoma : a tumour of schwann cells surrounding CNVIII
Functions of CNVII
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
Routes of CNVII
IAM, middle ear, stylomastoid foramen and parotid gland
Branches of CNVII
Temporal Zygomatic Buccal Marginal Mandible Cervical
Parts of the temporal bone
Temporal
Zygomatic
Petrous
Mastoid
Give symptoms and treatment for pharyngeal pouch
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
Patient comes in with a sore throat, what are you differentials?
tonsilitis
glandular fever
laryngitis
epiglottis/ supraglottitis
What are the red flag symptoms you should be asking for in a hx for neck swelling?
night sweats
anorexia and weight loss
rash
malaise
Tonsilitis: causative organism and medication choice
group A beta haemolytic strep
PO Ben V not amoxicillin or ampicillin
Tonsillectomy bleeding
within 24 hours, go back to theatre
3-10 days plus associated fever, poor fluid intake: consider IV ABX
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
yes, absence of cough indicates tonsilitis
Have you ever had tonsilitis?
Lumps, swelling elsewhere? (generalised lymphadenopathy)
Abdo pain
Prodromal illness
Hepatomegaly
Ix for glandular fever?
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
For how long is glandular fever transmissable?
6 weeks (during this time no contact sports or heavy lifting
How does a quinsy present? How do you manage a quinsy?
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
causative organism of quinsy?
strep pyogenes or h-influenzae or anaerobes
red flag questions or signs for a pharyngeal neck infection?
drooling restricted neck movements high fever/septic can't breath displaced pharynx tongue swelling
who gets retropharyngeal abscesses?
50% of the time it’s children between 6-12 months of age, 96% of the time it’s those below 6 y/o
aetiology of a pharyngeal space infection
tonsils parotid gland nasopharynx odontogentic pharynx
aetiology of a pharyngeal space infection
adenitis suppuration (rouviere’s nodes)
trauma
foreign body
Ludwig’s angina presentation?
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)
Complications of DSNI?
carotid artery erosion (ICA-ECA- CCA)
mediastinitis
lemierre’s disease
rupture: lung abscess, pneumonia, empyema
Rare systemic complications of EBV?
CN palsies, Guillian Barre syndrome
Other viral diseases that can present like EBV?
HSV-1, CMV, HZV, hand foot and mouth disease
What other conditions do clinicans need to be alert to, particularly in developing countries?
HIV, TB, syphillis, diptheria
