Manjaly Flashcards
Most common cause of septal perforation
trauma
5 investigations for septal perforation
Routine bloods - FBC/U+E/ESR
c-ANCA
ACE
RF (RA, SLE, scleroderma)
Biopsy (r/o malignancy)
3 management options for septal perforation
nasal hygeine
nasal septal prosthesis (e.g. silicone button obturator)
surgical repair with local or free flap
describe the structure of the nasal septum
3 layered structure of bilateral mucoperichondrium over middle layer made up of quadrangular cartilage/perpendicular plate of ethmoid/vomer.
Infections which could cause septal perforation?
Syphilis, TB, fungal disease
Types of flap which could be used for septal perforation repair
mucoperichondrium
inferior turbinate
auricular cartilage
5 symptoms of cholesteatoma
hearing loss
discharge
vertigo
tinnitus
facial weakness
What frequency is Cahart’s notch seen at
2000Hz
4 treatment options for otosclerosis?
observation
conventional hearing aid
stapes surgery
bone conduction device/implant
what type of tympanogram will be seen in otosclerosis and why
As curve - normal middle ear volume and pressure but reduced compliance
3 audiometric tests for herpes zoster oticus
PTA
Acoustic reflexes
Electroneurography
4 treatments for herpes zoster oticus
analgesia
eye care
corticosteroids
aciclovir
4 symptoms of herpes zoster oticus
otalgia
hearing loss
pharyngeal ulceration
CN palsies
serological test for herpes zoster oticus
varicella zoster IgG
3 organisms involved in otomycosis
aspergillus niger
candida albicans
actinomyces
4 risk factors for otomycosis
topical antibiotics
water exposure
canal trauma
diabetes
2 radiological investigations for a vocal cord palsy
CXR
Computed tomography of skull base to mediastinum
2 treatments for an idiopathic VC palsy
SLT
Surgery to medialise affected VC
Causes of VC palsy
direct trauma to VC (e.g. intubation)
damage to RLN (cancer, trauma, surgery)
Surgical options for VC palsy
VC injections
thyroplasty
laryngeal reinnervation procedures
Presentation of laryngomalacia
stridor
mild tachypnoea
omega shaped epiglottis
laryngomalacia
investigations for laryngomalacia
laryngotracheobronchoscopy
polysomnography
treatment options for laryngomalacia
conservative
oxygen administration
surgery
surgical options for laryngomalacia
supraglottoplasty
tracheostomy
Laryngomalacia pathophysiology
collapse of supraglottic structures on inspiration
What happens to stridor on crying in laryngomalacia
WORSENS on crying on lying flat
What is the conservative management advice for laryngomalacia?
encouraging upright position on feeding
pacing feeding with frequent burping
feed thickening
reflux treatment to reduce any layngeal oedema
When should surgical treatment for laryngomalacia be considered
when failure to thrive
what to consider in patients with temporal bone fractures?
hearing
balance
facial nerve
CSF leak
How can temporal bone fractures be classified
otic capsule sparing or otic capsule involved
transverse or longitudinal
which temporal bone fracture is more likely to involve a CSF leak and which otic capsule
longitudinal - blow from side, CSF leak more common
transverse - from front/behind with otic capsule involved
management of facial nerve palsies following temporal bone fracture
complete, immediate onset - surgical exploration
incomplete, delayed onset - steroids
What would a glue ear audiogram demonstrate
Conductive hearing loss, particularly at low frequencies
Four management options for glue ear
watchful waiting
hearing aid
grommets
adenoidectomy
Two sequelae of glue ear
speech and language delay
AOM
name 5 factors which predispose to glue ear
downs syndrome
cleft palate
ciliary dyskinesia
cranial anomolies
history of radiotherapy
3 medical causes for oral candidiasis
systemic/inhaled corticosteroids
systemic antibiotics
chemo/radiotherapy
list 2 disease for oral candidiasis
diabetes
AIDS
Which bug is responsible for oral candidiasis
candida albicans
Treatment of oral candidiasis
nystatin oral suspension
fluconazole
itraconazole
Differential diagnosis of anterior triangle neck lumps
infective lymphadenopathy
branchial cyst
lymphoma
metastatic SCC
what does FNA reveal in a branchial cyst
cholesterol rich fluid
What is the embryological origin of a branchial cyst
2nd branchial cleft
5 indications for a tonsillectomy
recurrent tonsillitis
OSA
tonsilar malignancy
recurrent quinsy
snoring
Which tonsilar tissue does waldeyers ring contain
adenoid tissue
tubal tonsils
lingual tonsils
palatine tonsils
Complications of tonsillitis
peritonsillar abscess
retropharyngeal abscess
parapharyngeal abscess
scarlet fever
rheumatic fever
post strep glomerulonephritis
Complications of tonsillectomy
pain
bleeding
infection
dental/oral injury
6 measures for epistaxis
conservative
cautery
anterior nasal packing - rapid rhino/nasopore/merocel
floseal
foley catheter/BIPP
surgery
How many VC SCC present
stridor
change in voice
2 investigations for laryngeal ca
CT head/neck/chest
Microlaryngoscopy and biopsy
Surgical options for laryngeal papillomatosis
microdebrider
cold steel
carbon dioxide laser
When to offer adjuvent therapy in laryngeal papillomatosis and what adjuvent therapies?
gardasil vaccine
cidofovir (prevents HPC DNA synthesis, requires multiple injections into the papilloma)
Use when have over 4 procedures per year
How may vestibular schwannomas present
unilateral hearing loss
unialteral tinnitus
sensation changes in trigeminal nerve distribution
6 differential diagnosis of a CPA lesion
vestibular schwannoma
meningioma
cholesterol granuloma
facial schwannoma
epidermoid cyst
arachnoid cyst
4 treatment options for pharyngeal pouch
conservative
laser myotomy
endoscopic stapling
open surgical resection
2 features which would concern you about malignancy in a parotid lump
facial nerve palsy
pain
2 benign parotid lumps
pleomorphic adenoma
warthins
2 malignant parotid lumps
mucoepidermoid
acinic cell
adenoid cystic
management of benign vs malignant parotid lumps
benign - surgical excision
malignant - surgical excision +/- neck dissection +/- CRT
2 risks of CRT in oral cancer
mucostitis
osteoradionecrosis
name the point where the scala vestibuli and scala tympani meet
helicotrema
what is the modiolus
conical shaped central axis of cochlea
3 treatment options for salivary gland stones
symptomatic - increased fluid intake/analgesia
sialendoscopy and basket retrival of stone
surgical removal of gland
4 presenting symptoms of nasal polyps
sensation of nasal obstruction
rhinorrhoea
anosmia
catarrh
6 causes of hypothyroidism
hashimotos thyroiditis
iodine deficiency
drugs - amiodarone
radiotherapy
thyroid surgery
pituitary disease
2 causes of hyperthyroidism
graves disease
toxic multinodular goitre
treatment of hyperthyroidism
beta blockers
carbimazole
radioactive iodine
total thyroidectomy
Presentation of glomus tympanicum (paraganglioma)
CHL
pulsatile tinnitus
mass in ear or neck for other types of paraganglioma
name of classification system for paraganglioma
fisch classification
tissue origin of paraganglioma
neuroendocrine
List the 4 types of paraganglioma
glomus tympanicum
glomus vagale
glomus jugulare
carotid body tumour
Management of paragangliomas
monitor
radiotherapy
subtotal resection
radical tympanomastoid/neck surgery
Nerves passing through cribriform plate
CN 1 - olfactory nerve (with bulb lying above)
Anterior ethmoidal nerves
nerves passing through optic canal
CN 2 - optic nerve
vessels passing through optic canal
ophthalmic artery
nerves passing through superior orbital fissure
CN3 - Oculomotor
4 - trochlear nerve
V1 - ophthalmic division of trigeminal - lacrimal, frontal, nasociliary branches
6 - trochlear nerve
Vessels passing through superior orbital fissure
superior ophthalmic vein
branch of inferior ophthalmic vein
nerves passing through foramen rotundum
V2 - maxillary division of trigeminal nerve
vessels passing through foramen rotundum
atery of foramen rotunudm
emissary veins
nerves passing through foramen ovale
V3 - mandibular division of trigeminal nerve
lesser petrosal nerve
vessels passing through foramen ovale
accessory meningeal artery
emissary veins
other structures passing through foramen ovale
otic ganglion
nerve passing through foramen spinosum
meningeal branch of V3
Vessels passing through foramen spinosum
Middle meningeal artery and vein
Nerve passing through foramen lacerum
greater and lesser petrosal
Nerves passing through IAM
7 - facial nerve
8 - vestibulocochlear nerve
vessels passing through IAM
Labyrinthine artery
other structures passing through IAM
vestibular ganglion
nerves passing through jugular foramen
IX - glossopharyngeal
X - vagus
XI - accessory
vessels passing through jugular foramen
inferior petrosal sinus joining sigmoid sinus to form jugular bulb and become external jugular vein
meningeal branches of occipital and ascending pharyngeal arteries
nerves passing through hypoglossal canal
12 - hypoglossal nerve
nerves passing through foramen magnum
spinal cord
Spinal part of accessory nerve
vessels passing through foramen magnum
vertebral arteries
anterior and posterior spinal arteries
dural veins
other structures passing through foramen magnum
meninges
CRS diagnostic criteria
nasal obstruction +/- discoloured nasal discharge, plus at least one of
* facial pain/pressure
* reduction or loss of smell
For >12 weeks
Indications for FESS
CT demonstrating blocked osteomeatal complexes +/- polyps
Which nerves should be infiltrated with lignospan in MUA nasal bones
infraorbital
infratrochlear
dorsal nasal
nerves
which instruments can you use to elevate nasal bones
hills elevator
walsham forceps
6 symptoms of hypopharyngeal ca
weight loss
dysphagia
odynophagia
referred otalgia
bleeding
neck lump
investigations for hypopharyngeal ca
pharyngoscopy + biopsy
MRI/CT neck
CT chest
Which instrument is used to remove inhaled FB
ventilating bronchoscope
which instrument is used to remove oesophageal FB
rigid oesophagoscope
Which instruments can you use to remove FB in ear
Jobson horne probe
wax hook
Difference between osteoma and exostoses
osteoma - singular, pedunculated over bony suture lines
exostoses - multiple, bilateral, broad based bony protuberances
how may osteomas and exostoses present
hearing loss
wax impaction
recurrent infection
3 complications of mastoiditis
sigmoid sinus thrombosis
intracranial abscess
meningitis
XR soft tissue neck signs of a FB
loss of cervical lordosis
air fluid level
widended pre vertebral shadow
subcutaneous emphysema
which fishbones are radiolucent
mackerel, trout, pike
what do you use a blom singer valve for
transoesophageal voice prosthesis, for speech production in laryngectomy patients
What is compliance in tympanometry?
Ability of sound to pass into middle ear and beyond - i.e. ability of TM and bones to move in response to air pressure changes
How to grade sinusitis on a CT scan
Using the Lund-Mackay Grading System:
Each of the sinuses (frontal, maxillary, anterior ethmoids, posterior ethmoids, sphenoidal) is given a grade between 0-2 where 0 is clear, 1 is partially opacified, 2 is completely opacified.
The osteomeatal complex are graded separately where 0 is clear and 2 is blocked.
The total score is out of 24.
which systemic diseases are associated with rhinitis
CF
primary ciliary dyskinesia
Young syndrome
Samters triad
management of allergic rhinitis
- allergen avoidance
- nasal saline irrigation
- intranasal steroids
- intranasal antihistamines
- oral antihistamines
Complications of FESS
nasal - epistaxis, adhesions, anosmia, nasolacrimal duct injury
orbital - dipolipa, injury to orbit, orbital haemorrhage, visual loss
intracranial - CSF leak, meningitis, abscess
ddx inferior turbinate hypertrophy
physiological
acute rhinitis
allergic rhinitis
neoplasia
3 options for management of inferior turbinate hypertrophy
turbinoplasty
turbinate outfracture
high frequency ablation
describe the drainage of lacrimal system
Lacrimal gland is positioned in the superolateral aspect of the globe, the tears are drained by the upper and lower canaliculus which form the lacrimal sac. This drains into the nasolacrimal duct which opens into the inferior meatus.
inheritance pattern of HHT
AD
MRI pattern of inverted papilloma
cerebriform pattern
anterior bowing of posterior maxillary wall on saggital CT scan
holman miller sign - juvenile angiofibroma
cookie bite pattern on PTA
hereditary hearing loss
type As tymp causes
otosclerosis
tympanosclerosis
two causes of type c tymp
ETD
OME
three causes of type B tymp
wax/FB
OME
Grommet
TM perf
masking rules
Masking is required when:
Rule 1
Difference in air conduction between each ear, equal to or greater than 40dB
Rule 2
Difference in bone conduction threshold and the air conduction threshold of either ear is greater than 10dB.
Rule 3
When rule 1 has not been applied, but where the bone conduction threshold of one ear is better by 40dB than the air conduction threshold of the contralateral ear.
Name FIVE differentials for a child presenting with a nasal polyp ?
Cystic Fibrosis. Meningocephalocele. Encephalocele. Juvenile Angiofibroma. Mucocele. Antrochonal polyp.
What is Furstenberg sign ?
A sign used to differentiate encephaloceles and meningoceles, from intranasal masses. On crying - effectively performing a valsalva manoeuvre - encephaloceles and meningoceles will expand, whereas an intranasal mass will not.
What causes velopharyngeal insufficiency ?
Failure of closure of the sphincter created by the soft palate and pharyngeal walls. This results in air escape through the nose causing hypernasal speech and intermittent passage of liquids.
What are the treatment options for a cystic hygroma ?
Conservative, Sclerotherapy, Surgical Excision
What is the treatment for choanal atresia ?
Acute:
- Intubation
Elective:
- Transpalatal repair
- Endonasal repair
- Stent vs. Flap
Name FIVE associations with choanal atresia presence ?
Maternal Vitamin D Deficiency, Coffee, Smoking, Thyroid medication, Syndromes (CHARGE, Treacher Collins, Crouzans)
What is Jackson’s Sign ?
Pooling of saliva in the piriform fossa.
Name FIVE muscles that make up the pharynx ?
Superior, middle, inferior constrictor, stylopharyngeus and salpingopharyngeus
Name THREE surgical treatment options for a unilateral vocal cord palsy ?
Temporary injection with Hyaluronic acid / Calcium hydroxyapatite. Permanent injection with fat. Thyroplasty.
Name FOUR treatment options for a bilateral vocal cord palsy ?
Laser arytenoidectomy, arytenoid suture lateralisation, bilateral selective reinnervation, laryngeal pacing, tracheostomy
What are your differentials for a cholesteatoma ?
Cholesterol Granuloma, Keratin Debris, Squamous Cell Carcinoma, Keratosis Obturans, Rhabdomyosarcoma, Meningoencephalocele
Name THREE tumours of the middle ear ?
Paraganglioma (Glomus Tympanicum, Jugulare, Vagale).
Sqaumous Cell Carcinoma.
Middle Ear Schwannoma (usually from the facial nerve)
What are the layers of the tympanic membrane ?
Outer epithelial layer.
Middle fibrous layer.
Inner mucosa layer.
Name FIVE differentials for a pinna swelling ?
Pinna seroma, haematoma, abscess, lipoma, sebaceous cyst, perichondritis
What is the Sade Classification ?
Classification for Pars Tensa Retraction.
1. Retraction of TM over annulus
2. Retraction of TM along long process of incus
3. Retraction of TM onto promontory
4. Adhesion of TM to promontory
What is the Tos Classification ?
Classification for Pars Flaccida retraction.
1. Dimple in the attic
2. Retraction and draped TM over the malleus
3. Draped TM with erosion of the scutum
4. Deep retraction with unreachable accumulated keratin
What is the sequence of the auditory pathway ?
ECOLI: Eight Nerve -> Cochlear nucleus -> (superior) Olivary complex -> Lateral Lemniscus -> Inferior Colliculus
What is Eagle Syndrome ?
A condition that results in the elongation of the styloid process or calcification of the stylohyoid ligament.
What are the symptoms of Eagle Syndrome ?
Presentation: unilateral neck or ear pain with symptoms worsening on neck movement.
What are the EIGHT branches of the External Carotid Artery ?
- Superior Thyroid Artery
- Ascending Pharyngeal Artery
- Lingual Artery
- Facial Artery
- Occipital Artery
- Posterior Auricular Artery
- Maxillary Artery
- Superficial Temporal Artery
Name THREE head and neck cancers that are associated with Ebstein-Barr virus.
Burkitts Lymphoma. Hodgkin’s Lymphoma. Nasopharyngeal Carcinoma.
Name THREE differentials for a basal cell carcinoma of the skin.
Squamous Cell Carcinoma. Keratoacanthoma. Dermatofibroma. Malignant Melanoma.
What is the Le Fort Classification ?
Le-Fort 1 involving only the alveolar ridge of the maxilla.
Le-Fort 2 - pyramidal fracture and involving nasofrontal suture line.
Le-Fort 3 - Horizontal fracture causing craniofacial disjunction.
What are the boundaries of the trauma neck zones ?
Zone 1 : Upper Clavicle to Cricoid
Zone 2 : Cricoid to Mandible
Zone 3 : Mandible to Skullbase
What are your differentials for a white lesion in the oral cavity ?
Canidia, Leukoplakia, Lichen planus, aphthous ulcer, squamous cell carcinoma
How would you investigate a patient with a thyroid lump ?
Baseline TFTs, Thyroid auto-antibodies, USS Neck + FNA, Cross sectional imaging if evidence of retrosternal extension
What is a Ranula ?
Ranula is a mucus extravasation pseudocyst in the floor of mouth.
Name FIVE differentials for an oral ulcer ?
Aphthous ulcer
Herpes simplex
Behcets syndrome
SCC
Pemphigoid vulgaris
Name THREE nerves that can be injured in a Level 2 neck dissection ?
Accessory, Hypoglossal, Marginal Mandibular Nerves
Name SIX structures within the Cavernous Sinus ?
O: oculomotor nerve
T: trochlear nerve
O: ophthalmic branch of trigeminal nerve
M: maxillary branch of trigeminal nerve
C: internal carotid artery
A: abducens nerve
T: trochlear nerve
What divides Level V in the neck ?
Lower border of cricoid.
Name 2 situations where a bone anchored hearing aid is more appropriate than a conventional hearing aid
congenital malformations of middle/external ear
microtia
chronically discharging ear
which thyroid ca gives an elevated calcitonin
medullary
How to proceed with Thy1 result
repeat FNA - inadequate sample
Which thyroid ca do we not use radioiodine in
medullary
how does a FESS lead to epiphoria
nasolacrimal duct injury because middle meatal antrostomy has been extended too far
Causes of epiphoria
FESS nasolacrinmal duct injury
dacrocystitis
nasolacrimal duct obstruction (blockage, strictures)
Management of epiphoria
conservative - massage, compression, probing nasolacrimal duct
endoscopic dacrocystorhinostomy
go through CT sinuses anatomy
CT anatomy
two reasons for speech delay in children with downs
hearing difficulties
high arched palate
lower facial muscle tone
4 reasons for OSA in children with downs
hypotonia
obesity
tonsillar/adenohypertrophy
macroglossia
midface hypoplasi
3 complications of button battery in nose
- mucosal ulceration/erosion/inhalation
- septal perforation
- Late nasal stenosis/adhesions
3 complications of button battery in ear
- chemical burn/OE
- TM perforation
- granulation formation/ulceration
- Hearing loss
Investigations for suspected button battery ingestion
Lateral soft tissue neck Xray
AP chest xray
Abdominal xray
Management of button battery in cervical oesophagus
urgent endoscopic removal under GA
Complications of ingested button battery
Oesophageal perforation
Mediastinitus
Stenosis/tracheo-oesophageal fistula
5 examination findings of nasal fracture
bony deviation to L/R
wide nasal bridge
external lacerations
bilateral ecchymosis
epistaxis
management of septal haematoma
immediate incision and drainage
Management of nasal bone fracture
MUA/reduction within 3 weeks
Sequelae of SRP
periorbital bruising/ecchymosis
septal perforation
saddling/supratip depression
numbness
revision surgery/residual deformity
septal haematoma/abscess
epistaxis
nasal obstruction
Muscles attached to styloid process
stylohyoid
stylopharyngeus
styloglossus
ligaments attached to styloid process
stylohyoid ligament
stylomandibular ligament
Tonsil/tongue base tumour mass investigations
panendscopy
biopsy/tonsillectomy
FNAC of lymph nodes
Risk factors for oropharyngeal ca
smoking
HPV
alcohol
previous radiotherapy
Presenting symptoms of oropharyngeal ca
trismus
sore throat
otalgia
odonophagia/dysphagia
neck lump
mass in throat (globus)
weight loss
Causes of unilateral SNHL
CPA lesion
viral
idiopathic
autoimmune
trauma
4 management options for hearing loss
do nothing
CROS hearing aid
BAHA
Hearing therapy
Why is choanal atresia when bilateral a neonatal emergency
neonates are obligate nasal breathers
Presentation of neonate with bilateral choanal atresia
respiratory distress with sternal recession/intercostal recession
cyanosis
immmediate management of bilateral choanal atresia
oropharyngeal airway/ET tube
Confirm diagnosis of choanal atresia
nasal catheter
Nasendoscopy
Check for misting
Definitive management for choanal atresia
surgical opening of choanae via transnasal or transpalatal route
Investigations for CHARGE syndrome
cardiac assessment with echo
renal US, renal function test
Ophthalmology assessment
audiological assessment
How may unilateral choanal atresia present
usually later in life with unilateral nasal obstruction
or unilateral nasal discharge
If you see a tongue/oral cavity lesion where else must you examine
neck
throat/oharynx/larynx/nasendoscopy
risk factors for oral cavity ca
smoking
chewing tobacco
chewing betel nut
alcohol
previous radiotherapy/radiation
investigations for oral cancers
biopsy
CT neck
CT thorax
MRI
Management of oral ca
surgery
CRT
Presenting symptoms of a quinsy
pain/odonophagia
fever
trismus
altered voice
dysphagia
Management of quinsy (4)
IV abx
needle aspiration
I+d
Acute tonsillectomy
ddx of unilateral pharyngeal swelling
tonsillar cancer
deep lobe of partoid tumour
lymphoma
abberrant blood vessel
paraphayrngeal abscess
What type of rash is seen in varicella zoster oticus
vesicular rash
Where is VZV found when dormant
geniculate ganglion of facial nerve
describe distribution of rash in herpes zoster oticus
distribution follows greater petrosal nerve
what to use to measure stapedial responses
tympanometer with stimulus above 80dB threshold
Treatment of herpes zoster oticus
urgent initiation of steroids, antivirals, analgesia, + eye care and advice
2 audiometric tests for otosclerosis
tympanometry
stapedial reflexes
management otosclerosis
no treatment
hearing aid
stapes surgery (stapedectomy/stapedotomy)
BAHA
Examination findings of glue ear
retracted TM
Middle ear effusion
dull
intact drum
bubbles
Describe the tympanogram expected in glue ear
flat trace with normal ear canal volume
Management of glue ear (medical)
otovent
hearing aid
conservative/watchful waiting
risks of grommet insertion
ear infection
pain
bleeding
persistent perforation
tympanosclerosis
risk factors for glue ear
parental smoking
overcrowding
nursery
lower socioeconomic class
OP note salient points e.g. grommets and adenoids
Patient details (name, DOB, MRN)
Op date
Surgeons name
Anaesthetists name
Operation title
indication for surgery
Findings
Procedure
Haemostasis
Post op instructions (how long to observe for, when to discharge, when will be followed up)
Signature
Printed name and GMC
Legibility
Complications of AOM
sub-periosteal abscess
inctracranial abscess
sigmoid sinus thrombosis
presentation of a child with AOM and complications
confusion/irritability/seizures
earache/headache
fever
deafness
vertigo
ataxia
Management of mastoiditis
urgent drainage/mastoidectomy of affected side + IV antibiotics
why does a saddle deformity occur
loss of septal support
systemic conditions causing saddle nose
leprosy
lymphoma
granulomatosis with polyangiitis
sarcoidosis
vasculitis
SLE
rheumatoid arthritis
polyarteritis nodosa
Tuberculosis
syphilis
relapsing polychondritis
surgical cause of saddle nose
septoplasty
management of septal haematoma/abscess
antibiotics
I+D/aspiration
quilting suture
nasal packing
materials which can be used for septoplasty
ear cartilage
rib cartilage
permacol
teflon
bone graft
gortex
early complications of septoplasty
bleeding
infection
deformity
skin ulceration
adhesions
US features suggestive of thyroid ca
hypoechogenicity
microcalcifications
increased vascularity
irregular margins
invasion into local structures
loss of elasticity
absence of halo effect
4 treatments for differentiated thyroid ca
surgery (total/hemi thyroidectomy)
post op radioactive iodine
suppressive thyroxine treatment
external radiotherapy
3 blood tests to monitor recurrence of differentiated thyroid ca
serum thyroglobulin level
serum thyroglobulin antibody
serum TSH
CEA
Calcitonin
risk factors for thyroid ca
radiation
MEN syndrome
hypothyroidism
Hashimotos thyroiditis
where do vocal cord nodules occur and why
at the junction between the anterior third and posterior 2 thirds of the vocal cords because this is the position where there is maximal vibration of the vocal cords
management of vocal cord nodules
SLT
Surgery
Causes of Reinke’s oedema
smoking
hypothyroidism
GORD
voice misuse
Management of Reinke’s oedema
smoking cessation
PPI/thyroxine/antireflux
SLT
surgery (Microlaryngoscopy, decompression conserving epithelium)
initial management of TM perf
analgesia if needed
Keep ear dry
be able to identify chorda tympani, umbo, promontory, long process incus, lateral process malleus, round window niche on image
be able to label cribriform plate, medial rectus, ethmoid sinus, lamina paprycea, uncinate process, middle turbinate, septum, maxillary sinus, maxilla on CT sinuses
Complications of breach of lamina paprycea
surgical emphysema of orbit
diplopia
loss of vision
haematoma
which structure needs to be removed to gain visualisation of maxillary ostium
uncinate process
complications of breach of cribriform plate
unilateral clear rhinorrhoea
headache
photophobia
neck stiffness/meningitis
be able to label handle of malleus, long process of incus, promontory (basal turn of cochlea), round window, lateral process of malleus, attic/pars flaccida, stapedius tendon, annulus
CT with SCC fistula
Normal soft tissue neck XRAY labelled
ct neck labelled
Underlying chromosome NF1 NF2
NF1 - 17
NF2 - chromosome 22
Management of NF2 vestibular schwannomas
surveillance
Small tumours - serial MRI
Surgery for large symptomatic tumour
stereotactic radiosurgery
3 symptoms pinna haematoma
sensation of fullness
pain
paraesthesia
3 signs pinna haematoma
swelling with loss of typocal auricular landmarks
discolouration
tenderness on palpation
3 complications if pinna haematoma left untreated
infection
cartilage necrosis
cauliflower ear deformity
which medication to avoid in Churg Strauss
Montelukast
eye socket anatomy
post op laryngectomy care
Monitor for signs of respiratory distress or bleeding
Chest physio as required
Regular suctioning as required
Stoma care BD at least - remove any crusts gently with saline if required
Monitor wound for bleeding, swelling, infection, breakdown
Humidified O2 as per protocol
Nebulised saline as needed
NG feeding
Remove stoma sutures after 7-10 days
Voice options available to stoma patients
surgical voice restoration - voice prosthesis into a tracheoesophageal fistula. Provox and Blom Singer valve.
Oesophageal speech
Artificial larynx
Intraop chyle leak identified - management
ligation of thoracic duct with clips or oversewing with non absorbable suture
sclerosing agents
Sequelae of chyle leak
infection
poorer wound healing
flap necrosis
chylothorax
identification of chyle leak intraop
creamy/milky fluid seen
can use manouevers to increase intrathoracic or intraabdominal pressure to help - ask anaesthetist to trendelenburg position or valsalva
post op chyle leak management
Conservative - bedrest, stool softeners, elevate bed to 30 degrees, dietician input for a low or non fat diet, monitor electrolytes, may need TPN, suction drainage
Medical - somatostatin, octreotide
Surgical rexploration
Radiological investigation for chyle leak
Lymphangiography
IR option for chyle leak
thoracic duct embolisation
what to remove to prevent recurrence of thyrglossal cyst
remaining thyroglossal tract
middle third of hyoid bone
Clinical tests to confirm trache position after trache change
auscultation of lungs
chest rise
misting of the tube
FNE
why do paediatric trache’s block more than adult
childs trachea is shorter, narrower, smaller cross sectional area
childs airway cartilage is softer, more likely to collapse under pressure
mucous membranes in children covering supraglottic and subglottic areas are looser in children and more susceptible to oedema when injured/inflamed
Epiglottis is U shaped and may obstruct laryngeal inlet
immature cilia so secretions so poorer secretion clearance than adults
more mucous cells - more secretions than adults
INSTRUMENTS
oral lesions
