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Emergency ENT Flashcards

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1
Q

List three causes of airway obstruction

A

foreign body
tongue enlargement
angioedema
goitre
tonsil bleed
larynx infection
trauma (+ facial)
bilateral vocal cord palsy

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2
Q

List three airway noises

A

stridor
stertor
silence
speaking in sentences

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3
Q

If stridor is inspiratory, where is the pathology?

A

larynx

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4
Q

If stridor is expiratory, where is the pathology?

A

tracheobronchial

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5
Q

When would you see epiglottitis?

A

in unvaccinated patient
Haemophilus influenzae type b (Hib) vaccine

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6
Q

When should you have high suspiscion for suprglottitis?

A

born before 1992- no vaccine schedule

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7
Q

Four aspects of management for airway obstruction?

A

oxygen
airway maneouvres
airway adjuncts
senior help
nebulised adrenaline
IV steroids 4mg
NBM

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8
Q

What is the dose of nebulised adrenaline?

A

1:1000 1mg in 5 ml N saline

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9
Q

Where is tracheostomy placed?

A

3rd -4th trachel ring to avoid glottis and prevent stenosis

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10
Q

Why is the nose not as dangerous as throat for foreign body to get stuck?

A

inferior turbinate structure reduces airway obstruction risk

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11
Q

Two differentials for sore throat

A

Quinsy
glandular fever
epiglottitis/supraglottitis
deep neck space infection

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12
Q

Why is penicillin given for tonsillitis and not amoxicillin?

A

if glandular fever, amox can cause rash

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13
Q

What is trismus and when is this commonly seen?

A

decreased mouth opening- quinsy

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14
Q

Management of quinsy?

A

drain abscess
admit
IV abx +- dexamethasone
tonsillectomy >1 episode

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15
Q

What is ludwig’s angina?

A

Ludwig’s angina is a bacterial infection (cellulitis) that affects your neck and the floor of your mouth. It is not contagious. It typically starts from a tooth infection (abscessed tooth). This rare type of cellulitis can spread rapidly, causing life-threatening swelling that can affect your ability to breathe.

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16
Q

One example of deep neck mass?

A

ludwig’s angina
retropharygneal abscess

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17
Q

How to determine whether necrotising/malignant externa?

A

pain keeps them up at night, then discharge
diabetic
immunocompromised
facial palsy

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18
Q

Three complications of acute otitis media?

A

intracranial abscess
facial palsy
mastoiditis
meningitis

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19
Q

Two serious complications of sinusitis?

A

periorbital cellulitis
pott’s puffy tumour- swollen head

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20
Q

How to determine whether nose blood is anterior or posterior?

A

blood trickling down throat- posterior

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21
Q

Name a hereditary cause of epistaxis

A

HHT- hereditary haemorrhagic telangiectasia

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22
Q

1st aid for nose bleed?

A

head foward bent over bowl/sink
pinch soft part of nose
ice in mouth??

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23
Q

How should you approach nose bleeds?

A

like any bleeding patient e.g. variceal bleeding

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24
Q

What are the conservative management options of epistaxis?

A

cautery of bleeding vessels
nasal packing

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25
Three differentials for epistaxis?
trauma nasal septal deviation/perforation iatrogenic- antithrombotic medications inflammation foreign body malignancy systemic disorders
26
What is the walrus sign?
incorrect way to insert anterior nasal pack
27
You spot a septal haematoma. When should ENT see this patient and why?
that day!!! risk of abscess, necrosis can lead to septal perforation
28
Treatment of septal haematoma?
aspiration
29
When should fractured nose without septal haematoma be seen?
assessment 5 to 7 days for reduction of swelling manipulation before 14 days
30
Three differential causes for facial nerve palsy?
acoustic neuroma schwannoma ramsay hunt syndrome lyme disease syphillis meningitis Idiopathic- most common Tumour Trauma Infection
31
Name two organisms associated with bell's palsy
CMV EBV HSV-1
32
Which scale is used for facial palsy
House Brackmann, I-VII
33
Patient has Facial nerve paralysis and vesicles on pinna and mouth. What is the diagnosis?
ramsay hunt syndrome
34
Which virus causes ramsay hunt syndrome?
herpes zoster
35
Is vertigo an emergency??
no not at all, should not be in A&E with isolated symptom
36
Three signs of base of skull fracture?
panda eyes post auricar haematoma/bleeding facial palsy haema tympania- blood behind tympanic membrane
37
What is halo sign?
discharge coming from ear double ring- blood and CSF
38
What is a rule for origin of arteries in the head?
if begin with vowel then all internal carotid if begin with consonant then all external carotid e.g. sphenopalatine- external carotid ant ethmoid- internal carotid
39
List three sites for nose bleeds
little's area sphenopalatine anterior ethmoid
40
If the origin of nose bleed is not the septum, where else can bleed originate from?
septum= little's area sphenopalatine- 80% anterior ethmoid- 20%
41
What is the ladder approach to epistaxis?
First aid- pressure Cautery Anterior packing Posterior packing Embolisation Surgery
42
Management of epistaxis?
Ladder Manage blood pressure INR and blood thinning medication- hold off giving Vit K if on warfarin...
43
Patient with epistaxis and purple dots on lips. Broken blood vessels all over face. What is the diagnosis?
HHT
44
Patient has deviated nose. Where do you manipulate to correct the fracture?
the bone (higher up) and not the soft cartilaginous part
45
Weird structure in nose/odd rhinology presentation, what should you think about?
cocaine use Wegner's
46
What is a quick way to determine whether someone has orbital cellulitis/how severe the infection is?
red colour testing if they can't distinguish colour then worry!
47
Which imaging should you do for orbital cellulitis
CT contrast orbit and brain
48
Which protein do you test for in CSF leak?
Beta2 transferrin
49
What is the most painful ear presentation?
otitis externa- admit for pain relief
50
What is a serious presentation of otitis externa?
malignant/necrotising otitis externa
51
What is an aberrant feature of malignant otitis externa
facial paralysis
52
Name two risk factors for malignant otitis externa
diabetes immunocompromised
53
Battle haematoma is a sign of?
temporal bone fracture
54
Patient has had two quinsys in one year. Should they get tonsillectomy?
yes!! >2 in one year
55
What is the 'mother of all emergencies'?
epiglottitis- watch out for in kids especially
56
Does stridor always feature in epiglottitis?
not always!!! always act on suspicion
57
What is the most common reason for someone having tracheostomy?
9/10 due to ICU admission with inability to wean off trachey
58
Name two differences between quinsy and tonsillitis?
quinsy- stertor and trismus anterior arch being pushed medially and a deviated uvula tonsillitis- you can see anterior arch
59
When can tonsillitis/quinsy patient be discharged?
eating and drinking again apyrexial no pain
60
Antibiotics for tonsillitis?
benpen
61
Why must you assess the abdomen with any tonsillar swelling?
Differentials: glandular fever, quinsy, deep neck infection, tonsillitis Glandular fever- risk of splenic rupture
62
What discharge advice should you offer to glandular fever patient
no contact sport or alcohol for 4-6 weeks
63
What is the tonsillectomy rule?
2, 5, 7 2 quinsy in one year 5 tonsillitis in two years 7 tonsillitis in one year
64
Aside from tonsillitis, name one other indication for tonsillectomy?
emergency airway obstruction obstructive sleep apnoea

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