Emergency

Question 1

Describe the movement of the epiglottis and vocal cords

Answer 1

They open up when we breathe and close when we swallow

Vocal cords are close together during phonation

Question 2

List the special features of the airway in children and babies

Answer 2

They breathe through their nose 
Have a relatively large tongue and large head 
Small and soft larynx that sits higher 
Weak neck muscles 
Floppy head

Question 3

What is the equation for air flow resistance

Answer 3

Its proportional to 1 over the radius to power 4

Exponential increase in resistance as the radius gets smaller

Question 4

List common causes of airway obstruction

Answer 4

Inflammation 
Infection 
Allergy 
Foreign bodies 
Physical compression 
Trauma 
Burns 
Neurological causes 
Neoplastic causes 
Congenital problems

Question 5

List symptoms of airway obstruction

Answer 5

SOB 
Coughing 
Choking 
Sternal or subcostal recession 
Dysphagia 
Dysphonia 
Cyanosis 
Stridor

Question 6

List signs of acute epiglottitis

Answer 6

Red, swollen epiglottis
Breathlessness
Drooling

Question 7

What causes recurrent respiratory papillomatosis

Answer 7

HPV infection

There is no cure

Question 8

What can respiratory distress progress on to

Answer 8

Respiratory failure
Respiratory arrest
Cardiac arrest

Question 9

How do you manage an airway obstruction

Answer 9

A,B,C: Resuscitation
Oxygen
Heliox - helium mixed with oxygen 
Steroid
Adrenaline
Endoscopy 
Tracheostomy (if needed) 
Treat underlying problem

Question 10

List signs of nasal trauma

Answer 10

Bruising and swelling 
Tenderness 
Deviation 
Epistaxis 
Cranial nerve dysfunction

Question 11

What is a septal haematoma

Answer 11

Bulging mass in nostril – seen on otoscope
Blood under the perichondrium – loss of blood supply to cartilage
Occurs after trauma
Treat by draining and sewing back into place

Question 12

List complications of nasal trauma

Answer 12

Epistaxis
CSF leak
Meningitis
Anosmia

Question 13

How do you treat nasal fracture

Answer 13

Treatment is based in deviation, breathing and cosmesis
Leave for 5-7 days to let swelling settle
If needed use digital manipulation

Question 14

What is epistaxis

Answer 14

Nose bleed

Question 15

Which blood vessles are found in the nose and may lead to epistaxis

Answer 15

Sphenopalatine artery
Etmoid arteries
Greater palatine artery

Question 16

How do you manage a nose bleed

Answer 16

Apply external pressure to the nose and lean forward 
Ice 
Cautery 
Nasal packing 
Topical vasoconstrictors 
Remove any clots

Question 17

At what point does a nose bleed need medical attention

Answer 17

If it doesn’t stop in 20 mins

Question 18

What can cause a CSF leak

Answer 18

Fracture to part of the skull - usually ethmoid as so thin
It often resolves itself
Needs surgery if not

Question 19

What is a pinna haematoma

Answer 19

Caused by trauma to the outer ear - common in rugby
Bleed occurs under the perichondrium
If not treated the cartilage loses blood supply and becomes deformed - cauliflower ears

Question 20

How do you treat a pinna haematoma

Answer 20

Aspirate
Incision and drainage
Pressure dressing
Avoid contact

Question 21

How do you treat an ear laceration

Answer 21

Debridement
Closure - done under LA
Need antibiotics if cartilage is exposed

Question 22

What are the classifications of temporal bone fractures

Answer 22

Longitudinal or transverse

Question 23

Describe the presentation of longitudinal temporal bone fractures

Answer 23

Caused by lateral blows to head 
Bleeding from external ear canal 
Haemotympanum and ossicular chain disruption  cause conductive deafness
Facial palsy 
CSF leak from nose

Question 24

Describe the presentation of transverse temporal bone fractures

Answer 24

Caused by frontal blows 
Can damage facial and auditory nerves 
SN hearing loss 
more likely than long to cause hearing loss
Facial nerve palsy 
Vertigo

Question 25

What one foreign body must be removed from the ear immediately

Answer 25

Small batteries - chemical s can burn the ear

Question 26

How do you treat a bug in the ear

Answer 26

Drown it in oil and remove when able

Question 27

In terms of neck trauma, what is included in zone 1

Answer 27

``` Low down on neck: Trachea Oesophagus Thoracic duct Thyroid Vessels Spinal cord ``` Very dangerous area to injure

Question 28

In terms of neck trauma, what is included in zone 2

Answer 28

``` Middle of neck Larynx CN 10,11,12 Vessels – carotids, internal jugular Spinal Cord ```

Question 29

In terms of neck trauma, what is included in zone 3

Answer 29

``` Upper neck - between jaw and skull base Pharynx Cranial Nerves Vessels – Carotids, IJV, Vertebral Spinal Cord ```

Question 30

What are the signs of a deep neck space infection

Answer 30

``` Sore throat Limited neck movement Systemically unwell Febrile Red and tender neck ```

Question 31

How do you treat a deep space neck infection

Answer 31

Fluid resuscitation Intravenous antibiotics Incision and drainage of neck space

Question 32

What are the signs of an orbital fracture

Answer 32

``` Pain Red eye Decreased visual acuity or double vision Oedema Restricted eye movement Numb around eye Bruising ```

Question 33

What is seen on a CT of an orbital fracture

Answer 33

Tear drop sign | Caused by contents of orbits pushing through break

Question 34

Describe the Le Fort fracture classifications

Answer 34

1 - breaks horizontally above the upper teeth (through maxilla) 2 - Pyramidal shape to fracture, through maxilla, lacrimal bone, zygoma etc. over nose and under eyes 3 - transverse, whole lower face detached (lower orbit and nose etc)