ENT Flashcards
(56 cards)
what are the causes fo epistaxis?
idiopathic
truamatic
iatrogneic
froeign body
inflammatory (polyps, rhinitis)
neoplastic
HTN/coagulopathies
name the managemnt step by step of epistaxis?
- A-E (check for shock)
- pinch soft part of nose and lean forward (spit out blood) for 15 mins
- cautery with silver nitrate (with anterior rhinoscopy - anterior or rigid endoscope - posterior) + adrenaline topically if needed (IF able to LOCATE source of bleeding)
- nasal packing if all else fails (anterior +/or posterior pack)
- surgical ligation of radiological embolisation to sphenopalatine/anterior ethmoidal/external carotid
what are teh two complications from a nasal fracture?
- CSF leak
- septal heamatoma
what is teh initial management of a septal fracture?
- A-E
- exclude for septal heamatoma
- MUA within 2 weeks (after swelling has gone down)
- if major truama needs evacuation under GA with packing +/- suturing
what is teh main complication from a septal heamatom?
saddle nose deformity
what are nasal polyps?
benign growths than can be seen in chronic sinusitis due to extreme inflammation
normally bilateral (if unilateral must biopsy just in case malignant)
red flags for polyps?
polyps that are unilateral, fast growing, bleeding
what is teh best imaging for rhinosinusitis?
CT sinuses -> done if surgery planned
what is the surgical treatment done for chronic rhinosinusitis?
nasal polypectomy -> very high rate of recurrence
functional endoscopic sinus surgery to improve ventilation/drainage
septoplasty and reduction of inferior turbinates
name complications of functional endoscopic sinus surgery
bleeding, infection, CSF leak, visual loss or disturbnace
medical treatment for chronic rhinosinusitis?
- antihistamines
- topical nsala steroids
- oral steroids (1 wk course)
- oral ABx (at least 6-8 weeks)
what is the defintiion of rhinosinusitis?
2 symptoms of:
- nasal blockage
- nasal discharge or post nasal drip
- facial pain
- reduced or loss of smell
+/- endoscopic signs of polyps, mucopurulent discharge or oedema in middle meatus
+/- CT changes (mucosal or sinus changes)
what investigations are doen to test for alleric rhinitis?
- skin prick test for speicifc allergens
- RAST blood tests if SPT not possible (tests IgE antibodies)
tretament fro allergic rhinitis
- allegren avoidance
- nasal douching
- antihistamines
- topical nasal steroids
- immunotherapy
what defines the difference between mild and moderate allergic rhinitis?
mild: normal daily acitvities and sleep
moderate: impairment of daily activites nd sleep
what are the mian risk factors for head and neck cancer ?
alcohol (MAIN)
tobacco (MAIN)
beetle nut chewing for oral cavity malignancies
chinese ethnic origin for nasopharyngeal malignancy
male
what investigations are importnat to do for supsetced H&N cancers?
CT neck
panendoscopy or laryngopharyngo-oesophagoscopy with biopsy
FNA of lymph nodes is suspected spread
CT chest if mets suspetced
most common type of head and neck cancer
SCC (90%)
management of head and neck cancers?
- palliation
- radiotherapy to primary site +/- to neck +/ chemo
- surgery - endoscopic (laser) or open
where do the recurrent laryngeal nerves run and what is the consquence of injuring them during thyroid surgery?
run in the tracheo-oesophageal groove
- they suply muscles of larynx and sensation below vocal cords = hoarsness and airway obstruction porblems
complications of thyroid surgery?
- recurrent laryngeal nevre palsy (=hoarseness and airway obstruction)
- superior laryngeal nerve palsy
- bleeding
- infection
- pain
- laryngeal oedeam = airway obstruction
- hypoparathyroidism (if parathyroid glands removed by accident) = hypocalcemia
if thyroid carcinoma is suspected, woudl investigation needs to be done?
fine needle aspiration of nodule
OR can just do a hemithyroidectomy to do definitive histology if there is diagnostic uncertainty
what are teh signs of a septal heamotoma?
- pinky, large mass in either side of nasal airway (feels boggy when palpated, not firm (firm wld indicate you are touchign part of the deviated septum)
presentation of a pt with polyps?
- males, >40yo
- watery anterio rhinorrhea
- pururlent post nasal drip
- nasal obstruction
- sinusitis
- headaches
- snoring
