Minor Flashcards
A 28 year-old young man came to your clinic with complaint of hoarseness of voice of 6 months duration; he was seen by an ENT specialist who viewed mass on the glottis. Biopsy was taken and showed squamous cell carcinoma of the glottis. What could be the risk factor in this patient?
Select one:
a. History of chewing chat
b. EBV infection
c. HPV infection
d. History of alcohol intake
The correct answer is:
d. History of alcohol intake
Explanation:
Squamous cell carcinoma (SCC) of the glottis is strongly associated with tobacco smoking and alcohol consumption, which are the most significant risk factors. Chronic exposure to these substances damages the epithelial lining of the vocal cords, leading to malignant transformation.
• Chewing khat (chat): While khat chewing is linked to various oral and esophageal issues, it has no strong association with glottic carcinoma.
• EBV infection: Epstein-Barr Virus is more associated with nasopharyngeal carcinoma, not laryngeal carcinoma.
• HPV infection: While HPV can cause SCC in the oropharynx, it is less commonly linked to laryngeal cancer.
Thus, history of alcohol intake is the most relevant risk factor in this case.
Case presentation with treatment of tonsillitis then developed HGIF& unilateral neck swelling. with lateral x-ray showing pre veretebral lucency.
a) RETROPHAYNGEAL ABSCESS
b) .PARAPHAYNGEAL ABSCESS
c) LUDWING ANGINA
The correct answer is:
a) Retropharyngeal abscess
Explanation:
1. Clinical features:
• The patient presented with tonsillitis that progressed to high-grade intermittent fever (HGIF) and unilateral neck swelling.
• This is suggestive of a deep neck space infection, and retropharyngeal abscess is a common complication in this setting.
2. Lateral X-ray findings:
• Prevertebral lucency or widening is a classic radiological sign of a retropharyngeal abscess. It indicates fluid or pus collection in the retropharyngeal space.
3. Differential diagnoses:
• Parapharyngeal abscess: Typically causes more diffuse swelling in the angle of the jaw and lateral pharyngeal wall bulging but does not commonly show prevertebral lucency.
• Ludwig’s angina: Involves the submandibular space bilaterally and is associated with a “woody” swelling of the floor of the mouth, not prevertebral lucency.
Treatment of Retropharyngeal Abscess:
1. Urgent management:
• Airway assessment and securing if compromised.
2. Antibiotics:
• Broad-spectrum IV antibiotics (e.g., ampicillin-sulbactam or clindamycin).
3. Surgical drainage:
• Incision and drainage may be necessary if the abscess is large or causing significant symptoms.
4. Supportive care:
• IV fluids, antipyretics, and monitoring for complications like mediastinitis or sepsis.
A four-year-old female child was brought to a pediatric OPD with complaints of fever and right ear pussy discharge
of one week duration. Otoscopic examination showed, frank pus coming out of right ear canal and central right
tympanic membrane perforation. What is the best management option for this child?
o f
a s t i o n
a. Ear irrigation
O b. Ear wicking with Antibiotics
O c. Watchful waiting
Od. Systemic and local Antibiotics
The best management option for this child is:
d. Systemic and local Antibiotics
Explanation:
The child has symptoms and signs suggestive of acute suppurative otitis media (ASOM) with tympanic membrane perforation and pus discharge. This condition requires prompt treatment to manage infection, alleviate symptoms, and prevent complications.
1. Systemic antibiotics are necessary to address the infection and prevent its spread. Amoxicillin or amoxicillin-clavulanic acid is typically used as first-line treatment.
2. Local antibiotics (e.g., antibiotic ear drops) can directly target the infected site and aid in quicker resolution.
Other options:
• a. Ear irrigation: This is not recommended in active ear infections with perforation, as it may worsen the condition by spreading infection.
• b. Ear wicking with antibiotics: This can help with drainage, but it is not sufficient alone without systemic antibiotics.
• c. Watchful waiting: Inappropriate in the presence of persistent symptoms and signs of infection like fever, pus discharge, and tympanic membrane perforation.
Thus, combining systemic and local antibiotics is the optimal management approach.
A t u l term pregnant women was admitted t o a labour ward forthe last 36 hours. The obstetrician decided to perform
a cesarean section because o f dystosia, for which the patient and her husband agreed. During the operation, heavy
bleeding occurred and became paramount to do a total frusterectomy. Since the operation was done under general.
anesthesia, the patient gould not sign the necessary consent form for another major surgery. The doctor took her
fingerprint and did the operation. Unfortunately. the mother died on the OR table. The family took the case to court.
H o w should this case b e dealt with?
18
D a . The death can decur as a complication of underlying condition
C b . The family must understand the situation and drop the case from court
2c. The doctor should not have performed the operation without the patients signature.
d. The doctor and the family should be called to solve the case amicably
The correct approach to this case involves understanding both the medical and legal implications. The appropriate answer is:
a. The death can occur as a complication of the underlying condition.
Explanation:
1. Medical Context:
• The patient was already in a critical situation due to prolonged labor (dystocia) and heavy intraoperative bleeding. A total hysterectomy was performed as a life-saving measure to control hemorrhage.
• Death in such cases, although tragic, can occur as a complication of the patient’s critical condition despite the best medical efforts.
2. Legal and Ethical Aspects:
• Performing life-saving surgery without written consent is legally acceptable under implied consent in emergencies, especially when the patient is unconscious and delay could result in death.
• The doctor took reasonable steps by involving the family (husband) and obtaining a fingerprint as evidence of consent under the circumstances.
3. Resolution:
• The case should be reviewed thoroughly, including the documentation of the patient’s condition, the necessity of the surgery, and the consent process.
• The court may determine that the doctor acted in the patient’s best interest under emergency conditions, following medical and ethical standards.
Incorrect Options:
• b. The family must understand the situation and drop the case: While it is important to communicate with the family, they have the right to pursue legal action, and the case cannot be dismissed solely by asking the family to drop it.
• c. The doctor should not have performed the operation without the patient’s signature: This is incorrect, as implied consent applies in emergencies where delaying surgery would likely result in death.
• d. The doctor and family should solve the case amicably: While amicable resolution is ideal, the case must be handled in accordance with medical and legal protocols to ensure transparency and justice.
Ultimately, the court will evaluate whether the doctor followed established medical and legal practices under the given circumstances.
