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ENT Flashcards

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1
Q

What are 3 important complications of neck surgery?

A

Recurrent laryngeal nerve palsy (hoarseness: unilateral)
Bleeding (haematomas can rapidly cause respiratory compromise due to laryngeal oedema in confined space)
Damage to parathyroids (hypocalcaemia)

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2
Q

Management of acute otitis media

A

Analgesia
Amoxicillin if over 48h
Average duration about 4 days

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3
Q

Mx Eustachian tube dysfunction

A

Regular warm drinks +/- decongestants

Steroid nasal spray

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4
Q

Mx otitis externa

A

Keep dry

Abx ear drops/ spray

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5
Q

Mx perforated ear drum

A

Consider amoxicillin 1 week, refer if not improving (2-6 weeks)

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6
Q

Mx temoromandibular joint pain

A

analgesia, reassurance, relaxation

dentist if persists

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7
Q

Red flags for tinnitus

A

Unilateral
Head injury/ evidence of raised ICP
Suicidal ideation: chronic tinnitus is risk factor

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8
Q

Mx suspected dental abscess

A

See dentist
5-7 days amox if suspect abscess/ root canal infection
Add metronidazole if severe infection suspected

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9
Q

What is the FeverPAIN score?

A

Likelihood of strep infection causing tonsillitis:

Fever
Purulence
Attend within 3 days
Inflamed tonsils ++
No cough/ coryzal sx
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10
Q

Abx for strep throat

A

Pen V

reduces symptoms by 1 day!

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11
Q

Referral for tonsillectomy criteria

A

7 in 1 year
5 per year for 2 years
3 per year for 3 years

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12
Q

Most common bug causing otitis externa

A

Pseudomonas (swimmer’s ear) - can be other bacteria or herpes

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13
Q

Signs otitis externa

A

Otalgia
Swelling/ erythema: external ear, ear canal
Pain on manipulation of auricle
Debris in canal/ otorrhea

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14
Q

Mx otitis externa

A

KEEP EAR DRY
Mild: cleaning, dilute ascetic acid drops
Most: topical abx

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15
Q

What is malignant otitis externa?

A

Fulminant bacterial otitis externa

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16
Q

Who tends to get malignant otitis externa?

A

elderly with DM (doesnt seem to affect others with immunosuppression)

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17
Q

Which bug commonly causes malignant otitis externa?

A

Pseudomonas aeruginosa

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18
Q

Signs of malignant otitis externa

A

Classic feature: nub of granulation tissue on floor of external ear canal at bony-cartilaginous junction

Severe pain - excessive purulent d/c - maybe exposed bone

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19
Q

Mx malignant otitis externa

A

Monitor DM
extensive debridement
IV abx

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20
Q

Complications malignant otitis externa

A

Invasion of surrounding tissue to produce cellulitis
Osteomyelitis of temporal bone
Mastoiditis

Later: facial nerve palsy, meningitis, brain abscess

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21
Q

What does CT show in malignant otitis externa?

A

temporal bone erosion and inflammation

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22
Q

What tumours mos commonly form on the ear/ ear canal?

A

SCC

Sometimes BCC/ melanoma

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23
Q

Mx perf ear drum

A

Keep dry
Use systemic abx if signs of infection/ contamination
otherwise, most heal spontaneously

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24
Q

What is a cholesteatoma?

Study These Flashcards
A

Epidermal inclusion cyst of the middle ear/ mastoid, containing desquamated keratin debris (may be acquired or congenital)

25
Complications of cholesteatomas
Ossicular erosion (conductive hearing loss) local invasion, causing vertigo and sensorineural hearing loss facial paralysis CNS dysfunction/ infection
26
Mx cholesteatoma
surgery aiming to reconstruct ossicular chain
27
Microbe causes of acute otitis media
usually Strep pneumoniae (33%) H. influenzae other shit
28
Inheritance of otosclerosis
AD
29
What kind of signs in otosclerosis?
Conductive hearing loss with normal TM | Schwartze's sign: erythema around stapes from hypervascularity
30
Most common causes of sensorineural hearing loss
PRESBYCUSIS - leading cause acoustic injury from loud noises congenital (TORCHES: maternal toxoplasmosis, rubella, MMV, herpes, syphilis) In kids, most common cause is bacterial meningitis
31
Anterior epistaxis vessels
Kiesselbach's plexus (more common ~90%, usually associated with trauma)
32
Posterior epistaxis vessels
Sphenopalatine artery (elderly, HTN, tumour, anticoag)
33
Mx epistaxis Anterior packing for epistaxis Posterior packing Next steps
ABCDE Pressure, head forward A: gauze strips P: Foley catheter ``` Silver nitrate (need LA, stings) Embolisation or ligation of arteries ```
34
Early + late signs nasal ca
Early: nasal obstruction, blood-tinged mucus, epistaxis Late: localised pain, cranial nerve deficits, facial/ palate asymmetry, loose teeth
35
Complications of tonsillitis
Peritonsillar abscess (quinsy) Retropharyngeal abscess (causing airway compromise) Rheumatic fever Post-strep GN
36
Signs of quinsy
fever, odonophagia, hot potato voice cervical lymmphadenopathy Bulging, erythematous tonsillar pillar swelling of the uvula and displacement
37
Mx quinsy
IV abx | surgical excavation
38
Which salivary glands most commonly involved in pathology
Parotid and submandibular | Sublingual rarely affected
39
Which glands commonly affected by calculi?
Submandibular
40
How does calculi present?
Pain before and during eating
41
How is calculi confirmed?
can maybe palpate duct may be erythematous with purulent d/c visible on x-ray (mx by excising)
42
Signs and symptoms of mandibular fracture?
Pain! Disfigurement, malocclusion lacerations of gingiva haematoma in floor of mouth
43
Which nasal fractures need to go to theatre?
Septal haematoma: boggy painful bilateral swelling which is compressible cartilage can become ischaemic leading to saddle nose (cartilage loss)
44
How many parathyroid glands?
4
45
Common tumour marker for parathyroid carcinoma
beta-HCG
46
Signs suggesting parathyroid carcinoma
palpable mass + hypercalcaemia + PTH
47
Describe thyroglossal cyst
Mid-line, under hyoid bone Connected to base of tongue Cyst may become infected or dscharge
48
Why is radioiodine uptake necessary before removing thyroglossal cyst?
May contain some/ all thyroid tissue
49
Rule of 80 re neck lumps
80% in children are benign | 80% in adults over 40 are malignant
50
What is branchial cyst?
congenital abnormality - usually not apparent until adult life when an infection may precipitate problems upper anterior border of SCM mx aspiration (contains cholesterol crystals)
51
What level of hearing is normal on audiogram
anything above 20 dB
52
mx sinusitis
steroid spray | abx only if systemically unwell
53
causes of conductive hearing loss
wax, perf, OmE, Eustachian tube blockage
54
BPPV test and mx
``` Dix-Hallpike = test Epley = mx ```
55
Sx BPPV
seconds of dizziness, usually due to moving head no hearing loss no tinnitus
56
Sx acute labyrinthitis
sudden onset vertigo can be severe with N&V no hearing loss no tinnitus
57
Sx menieres
progressive | vertigo with nausea, tinnitus, progressive hearing loss, ear fullness
58
acoustic neuroma sx
``` unilateral hearing loss vertigo focal deficits sx raised ICP associated with neurofibromatosis type 2 ```

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