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ENT > N and airway > Flashcards

N and airway Flashcards

1
Q

What is stridor?

A

A high pitched inspiratory noise

Due to laryngeal obstruction

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2
Q

What does stridor lead to?

A 
Can lead to respiratory distress
Tracheal tug (increased effort) 
Costal recession (using ribs to breathe)
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3
Q

Ways of dealing with someone with Stridor

A

Keep patient and parent of child calm
Oxygen via a mask
Adrenalin nebuliser - every 20minutes as needed - decongestant - blood vessels constrict and linings smaller
Steroids - dexamethasone IV or prednisolone Oral or budesonide nebuliser

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4
Q

If medical management of stridor fails what do you do?

A

Establish airway through the skin - emergency tracheostomy - but usually not needed

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5
Q

Congenital causes of stridor x3

A

Congenital subglottic stenosis
Larygnomalacia
Bilateral vocal cord palsy

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6
Q

What is congenital subglottic stenosis?

A

Narrow/small cricoid cartilage

With infection will swell and therefore further narrowing leads to croup in children

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7
Q

What is laryngomalacia?

A

“floppy larynx”
Like a tulip bulb that hasn’t completely opened yet
Normally better by 2 years of age

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8
Q

Management of laryngomalacia?

A

Anti-reflux because effort to breathe in can suck acid up oesophagus and cause reflux
Rarely still persistent - but if it is and too much effort to breathe with poor weight gain - can open it up surgically

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9
Q

Management of bilateral vocal cord palsy

A

Children need tracheostomy 50% of the time

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10
Q

Acquired causes of stridor

A
  • Trauma (blunt or endotracheal tube prolonged intubation in premature baby) leads to scarring therefore acquired subglottic stenosis
  • Burn
  • FB
  • Infection
  • Neoplastic
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11
Q

Tumour cause of stridor in children and adults

A

In children mostly benign papillomas

In adults mostly neoplastic malignant eg. squamous carcinoma

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12
Q

What is stertor?

A

Low pitch inspiratory sound due to pharyngeal obstruction

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13
Q

What is stertor when you have complete blockages

A

Apnoea

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14
Q

Commonest cause of stertor/obstructive sleep apnoea in children and adults

A

Child - adenoid and tonsil hypertrophy

Adult - raised BMI

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15
Q

Treatment of child stertor

A

Remove tonsils and adenoids

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16
Q

Treatment of adult stertor/sleep apnoea

A

Lose weight
Mandibular advancement splint
Mask with pressure from a machine at night to hold airway open - CPAP

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17
Q

What is nose lined with?

A

Pseudostratified ciliated columnar epithelium

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18
Q

Associated features of nasal obstruction

A

Itching, sneezing, rhinorrhoea, epiphora (watery eye)
Purulence, facial pain, anosmia, postnasal drip
Blood discharge and pain

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19
Q

Significant history for nasal obstruction

A

Asthma
Previous surgery or trauma
Smoking
Pregnancy

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20
Q

Cancer red flags with nasal obstruction

A 
Persistent unilateral obstruction 
Bloody discharge 
Persistent pain 
Weight loss 
Cervical LN 
>50 years 
Woodworker - resins within hard woods are particularly irritant to nose and have been shown to be carcinogenic 
Previous polyps
Teenage boy with epistaxis
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21
Q

What is rhinomanometry

A

Tests of nasal airflow - nasal inspiratory peak flow

22
Q

4 congenital causes of nasal obstruction

A

Choanal atresia
Dermoid cyst
Meningoencephalocoele
Structural deformity

23
Q

What is choanal atresia and how treated

A

Opening from back of nose into nasopharynx hasn’t developed yet
Treated by putting a hole in the atresic plate

24
Q

What is a dermoid cyst and how treated

A

Cyst under the skin

Treated surgically

25
Q

What is meningoencephalocoele

A

Defect in skull base and brain comes down and causes obstruction

26
Q

Acquired causes of nasal obstruction

A

Trauma

Infective is rare but can get septal abscess

27
Q

What is a septal haematoma

A

Cherry red swelling bilaterally in the nose - pericondrium is stripped off the septal cartilage and if its not addressed in first 24hours - will lose septal cartilage

28
Q

Inflammatory causes of nasal obstruction

A

Allergic rhinitis
Rhinosinusitis
Adenoiditis
Vasculitis

29
Q

What is allergic rhinitis and how do you treat it?

A

Inflammation caused by airborne pathogen
Identify allergen and avoid it
Can also use topical steroids and/or antihistamines
Oral antihistamines if severe

30
Q

What is rhinosinusitis?

A

Sinusitis is an infection of paranasal sinuses
Usually bacterial
Most commonly associated with URTI but can occur with asthma

31
Q

Symptoms of rhinosinusitis?

A

Frontal headache
Purulent rhinorrhoea
Facial pain with tenderness
Fever

32
Q

Treatment of rhinosinusitis

A

Nasal douching
Topical nasal steroids
Lose dose antibiotics
If polyps - oral steroids and polypectomy

33
Q

What is adenoiditis

A

Inflammation of adenoid tissue at the back of the nose - often a pus-like discharge from the nose

34
Q

Upper midline neck lump

A

Thyroglossal cyst
Dermoid cyst
Lymph nodes

35
Q

Lower midline neck lump

A

Thryoid gland mass

Lymph nodes

36
Q

Upper lateral neck lump

A

Salivary gland
Neurogenic and vascular neoplasms
Lymph nodes

37
Q

Lower lateral neck lump

A

Lymph nodes

38
Q

Under 20 with a neck lump

A

Congenital
inflammatory
lymphomas

39
Q

20-40 years old neck lump

A

Branchial cyst
Salivary gland
Thyroid neoplasm

40
Q

over 40 neck lump

A

Malignant neoplasm

ANY Lateral neck lump in adult >40 is malignant until proven otherwise

41
Q

What is a branchial cyst

A 
2nd arch abnormality 
Usually after URTI 
Patients 15-20 
Usually painless 
Treatment is surgical
42
Q

How can you tell it is thryoglossal duct cyst

A

Will move with swallowing

43
Q

What is warthins tumour?

A

A benign tumour of the parotid gland

44
Q

Medication which can cause epistaxis?

A 
Warfarin 
Heparin
Aspirin
Clopidogrel 
Dabigatran, rivaroxaban, apixaban
Garlic
45
Q

Initial management of epistaxis?

A 
ABC
IV access and bloods
Pressure and ice pack 
Control HTN
Correct coagulopathies (FFP, whole blood, platelets, reverse anticoagulant)
Topical decongestants/vasoconstrictors 
Cautery 
Nasal packing
46
Q

Surgical treatment of epistaxis?

A

Artery ligation
Embolization - if still bleeding after ligation or bleeding site difficult to reach - or comorbities which prohibit GA - only effective when bleeding

47
Q

What is Samters triad

A

Triad of asthma, aspirin sensitivity and nasal polyps

48
Q

Management of Nasal polyps

A

Topical corticosteroids

49
Q

When do nasal polyps require further ENT investigation

A

Unilateral or epistaxis

50
Q

Management of allergic rhinosinusitis

A

Loratadine
Systemic decongestants - pseudoephedrine
Sodium chromoglicate nasal spray
Beclometasone steroid nasal spray

51
Q

Presentation of retropharyngeal abscess

A

Ill child with stiff, extended neck/torticollis who fails to eat or drink
Manage with incision and drainage

ENT (5 decks)

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