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1 ENT > Emergency ENT > Flashcards

Emergency ENT Flashcards

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
Q

Three differentials for epistaxis?

A

trauma
nasal septal deviation/perforation
iatrogenic- antithrombotic medications
inflammation
foreign body
malignancy
systemic disorders

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26
Q

What is the walrus sign?

A

incorrect way to insert anterior nasal pack

27
Q

You spot a septal haematoma. When should ENT see this patient and why?

A

that day!!! risk of abscess, necrosis can lead to septal perforation

28
Q

Treatment of septal haematoma?

A

aspiration

29
Q

When should fractured nose without septal haematoma be seen?

A

assessment 5 to 7 days for reduction of swelling
manipulation before 14 days

30
Q

Three differential causes for facial nerve palsy?

A

acoustic neuroma
schwannoma
ramsay hunt syndrome
lyme disease
syphillis
meningitis

Idiopathic- most common
Tumour
Trauma
Infection

31
Q

Name two organisms associated with bell’s palsy

A

CMV
EBV
HSV-1

32
Q

Which scale is used for facial palsy

A

House Brackmann, I-VII

33
Q

Patient has Facial nerve paralysis and vesicles on pinna and mouth. What is the diagnosis?

A

ramsay hunt syndrome

34
Q

Which virus causes ramsay hunt syndrome?

A

herpes zoster

35
Q

Is vertigo an emergency??

A

no not at all, should not be in A&E with isolated symptom

36
Q

Three signs of base of skull fracture?

A

panda eyes
post auricar haematoma/bleeding
facial palsy
haema tympania- blood behind tympanic membrane

37
Q

What is halo sign?

A

discharge coming from ear double ring- blood and CSF

38
Q

What is a rule for origin of arteries in the head?

A

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
Q

List three sites for nose bleeds

A

little’s area
sphenopalatine
anterior ethmoid

40
Q

If the origin of nose bleed is not the septum, where else can bleed originate from?

A

septum= little’s area
sphenopalatine- 80%
anterior ethmoid- 20%

41
Q

What is the ladder approach to epistaxis?

A

First aid- pressure
Cautery
Anterior packing
Posterior packing
Embolisation
Surgery

42
Q

Management of epistaxis?

A

Ladder
Manage blood pressure
INR and blood thinning medication- hold off giving Vit K if on warfarin…

43
Q

Patient with epistaxis and purple dots on lips. Broken blood vessels all over face. What is the diagnosis?

A

HHT

44
Q

Patient has deviated nose. Where do you manipulate to correct the fracture?

A

the bone (higher up) and not the soft cartilaginous part

45
Q

Weird structure in nose/odd rhinology presentation, what should you think about?

A

cocaine use
Wegner’s

46
Q

What is a quick way to determine whether someone has orbital cellulitis/how severe the infection is?

A

red colour testing
if they can’t distinguish colour then worry!

47
Q

Which imaging should you do for orbital cellulitis

A

CT contrast orbit and brain

48
Q

Which protein do you test for in CSF leak?

A

Beta2 transferrin

49
Q

What is the most painful ear presentation?

A

otitis externa- admit for pain relief

50
Q

What is a serious presentation of otitis externa?

A

malignant/necrotising otitis externa

51
Q

What is an aberrant feature of malignant otitis externa

A

facial paralysis

52
Q

Name two risk factors for malignant otitis externa

A

diabetes
immunocompromised

53
Q

Battle haematoma is a sign of?

A

temporal bone fracture

54
Q

Patient has had two quinsys in one year. Should they get tonsillectomy?

A

yes!!
>2 in one year

55
Q

What is the ‘mother of all emergencies’?

A

epiglottitis- watch out for in kids especially

56
Q

Does stridor always feature in epiglottitis?

A

not always!!! always act on suspicion

57
Q

What is the most common reason for someone having tracheostomy?

A

9/10 due to ICU admission with inability to wean off trachey

58
Q

Name two differences between quinsy and tonsillitis?

A

quinsy- stertor and trismus
anterior arch being pushed medially and a deviated uvula
tonsillitis- you can see anterior arch

59
Q

When can tonsillitis/quinsy patient be discharged?

A

eating and drinking again
apyrexial
no pain

60
Q

Antibiotics for tonsillitis?

A

benpen

61
Q

Why must you assess the abdomen with any tonsillar swelling?

A

Differentials: glandular fever, quinsy, deep neck infection, tonsillitis

Glandular fever- risk of splenic rupture

62
Q

What discharge advice should you offer to glandular fever patient

A

no contact sport or alcohol for 4-6 weeks

63
Q

What is the tonsillectomy rule?

A

2, 5, 7

2 quinsy in one year
5 tonsillitis in two years
7 tonsillitis in one year

64
Q

Aside from tonsillitis, name one other indication for tonsillectomy?

A

emergency airway obstruction
obstructive sleep apnoea

1 ENT (9 decks)

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