ENT stuff Flashcards
1
Q
Meniere Triad
A
Tinnitus,sensorineural Hearing loss and Vertigo
2
Q
ENT signs of head trauma
A
CSF otorrhea
CSF rhinorrhea
Hemotympanium
Battle sign
Raccoon eyes sign
3
Q
Tragus sign(putting pressure on the tragus) is a sign of?
A
Otitis externa or otitis media
4
Q
Mx of otitis externa
A
Pain relief:acetaminophen, ibuprofen, heat or cold pakcs, codeine(IF severe)
Definitive:
-uncomplicated OE: Floroquinolone ear drops+- polymyxin B +-bacitracin
- complicated OE: Oral Abx
5
Q
What constitutes complicated otitis externa
A
Acute Otitis media
Lymphadenitis
Facial cellulitis
Immunocompromised pt at risk of malignang otitis externa
6
Q
Complications of malignant otitis externa
A
Bacterial labyrinthitis
Mastoiditis
Cerebral abscesses
7
Q
What can cause paediatric pt to pull on the ear
A
Otalgia, pruritus, fullness
8
Q
Types of ear discharge
A
Ear wax
Ear drops
Purulent
Bloody
Clear,possibly CSF
9
Q
Giving ear drops in child below vs above 3yo
A
Below:pull pinna down and back
Above:pull pinna up and back
Then leave in lying position for 3-5mins
10
Q
Causes of mouth ulcers
A
Trauma eg falls
Infection eg HFMD/coxsackie, herpangina
Apthous ulcer
Rarely SLE or IBD
11
Q
Causes of enlarged lymph nodes
A
Infected due to bacteria
Reactive due to viral, bacterial infection
Inflammatory eg kawasaki disease
Malignancy:leukemia,lymphoma
12
Q
Causes of a groin rash in a child
A
Contact dermatitis(nappy rash)
Candidiasis
13
Q
Complications of BCG intradermal injection
A
Bleeding
Keloid
Infection and abscess
14
Q
Mx of nappy rash
A
Air dry, barrier cream, wash and keep clean
15
Q
Site of BCG injection
A
Left deltoid, left buttock
16
Q
Mx of skin candidiasis infection
A
Miconazole
Cotrimazole
Nystatin
17
Q
When is enuresis abnormal?
A
Most are toilet trained by 5, some may have enuresis after 7 but treat then with patience and do not shame them
18
Q
Causes of enuresis
A
1.Deep sleepers who don’t respond to full bladder
2.lack of ADH
19
Q
Enuresis mx
A
1.Lifestyle changes wrt to fluid intake and passing urine
2. Bladder training
3. Moisture alarms
4. Medications if serious
20
Q
Red flags for secondary enuresis
A
- Wetting bed after already being dry
- Hematuria
- Dysuria
- Polydipsia: Diabetes insipidus
- Day incontinence
- Constipation
- Weakness,abnormal sensation in legs(spina bifida,CES)
21
Q
Scoring for OSA
A
STOP BANG
Snoring
Tiredness
Observed apnoeas
Pressure high(blood)
BMI >35
Age >50
Neck circumference >40cm
Male gender
22
Q
Gold standard for OSA dx
A
Sleep study, standard polysomnography
23
Q
What is the PALM scale
A
Causes of OSA
24
Q
Score for predicting thyoid storm
A
Burch wartofsky score
25
Location of tracheostomy
Between 2nd and 3rd tracheal rings, 2-3 finger breadths above sternal notch
26
Parotidectomy scar nameq
Modified Blair incision
27
Vestibular suppresant example
Betahistine, can be given for any case of vertigo
28
Broad causes of hoarseness
Infectious
Inflammatory
Neoplastic
Others
29
Speech rehab options post total larnygectomy
1. Esophageal speech
2. Electrolarynx
3. Voice prosthesis
30
Treatments for larnygeal cancer
1. Trans other laser resection
2. Open:partial or total laryngectomy
3. Non surg: RT or chemo RT
31
Types of neoplastic causes of hoarseness
Vocal cord Nodule, cyst or polyp
Maligancy:SCC,Adenocarcinoma or sarcoma
32
Causes of vocal cord paralysis
Idiopathic
Iatrogenic: Intubation, thyroid or thoracic surgery
Infectious: Viral
Neoplastic: Thyroid, esophageal, lung
Traumatic: blunt or deep neck lacerations
33
Differing course of recurrent laryngeal nerve
Left goes under aortic arch
Right under SCA
34
Indications for tracheostomy
1. Prolonged ventilation
2. Airway protection
3. Airway obstruction
4. Tracheobronchial toilet
5. Surgical access
35
Intra op complications of tracheostomy
1. GA related
2. Airway fire
3. Injury to surrounding structures
4. Bleeding
36
Post op cx of tracheostomy
Early
-air leak syndromes
-infection
-bleeding
-obstruction/decannation
Late
-tracheal stenosis
-tracheal fistulas
37
Types of tracheostomy
Cuffed vs non cuffed
Fenestrated vs non fenestrated
Single vs double lumen
Adjustable flange
38
Indications for cuffed tracheostomy
1. Positive pressure ventilation
2. Aspiration risk
3. Bleeding risk
4. Unstable pt
5. New trachoestomy
39
Fenestrated tracheostomy indications
1. Spigotting
2. Phonation rehab
40
Single lumen vs double lumen tracheostomy
Single in paeds and better for ventilation
Double better for toileting
41
Indications for adjustable flange tracheostomy
Difficult anatomy eg thick neck, deep trachea
42
Frequency of tracheostomy tube change
Single lumen /1-2 weeks
Double lumen /1-3months
43
3 principles of thyroid mass Mx
1 Imaging: US
1 Blood test TFT
1 biopsy FNAC
44
Cx of an untreated pinna hematoma
1. Cauliflower ear
2. Pinna abscess
45
WHat is microtia
Underdevelopment/ dysplasia of the pinna
46
Risk factors for microtia
Teratoma
Syndromes
1. Digeroge/ cardio-velo-facial
2. Branchio-oto-renal
3. Treacher Collins
4. Goldenhar
47
Mx of microtia
Atresiaplasty and cosmetic autologous reconstruction
48
What is malignant otitis externa
Temporal bone osteomyelitis
49
Invx in a case of malingnant otitis externa
Biochemical
1. FBC
2. RP
3. CRP/ESR
4. Swab and blood culture+sensitivity
Imaging
1. CT temporal bone
2. MRI skull base
Proecdural
1. Biopsy tro SCC
50
Mx of Malignant Otitis Externa
1. Admission for IV Abx: Piptazo , ciprofloxacin or ceftazidime
51
Common causative pathogens for malignant otitis externa
Psuedomonas, then S Aureus then fungi
52
Cx of malignant otitis externa
1. Mastoiditis
2. Bacterial Labyrinthitis
3. Intracranial abscess with CN deficits
53
Cause of swelling and erythema of the pinna sparing the lobule
Perichondritis
54
Perichondritis Mx
Admit for IV piptazo, I&D
55
Cx of perichondritis
1. Cauliflower ear
2. Facial cellulitis
56
Causes of cauliflower ear
1. Trauma
2. Infection: Pinna abscess or perichondritis
57
Associated injuries in a hemotympanium
1. Ossicular chain disruption
2. base of skull fx
3. Mastoid fx
4. Labyrinthine concussion
5. Labyrinthine fistula
6. CN7 palsy( chorda tympani injury)
7. Carotid artery injury
8. TM perforation
58
Mx of hemotypanium
1. TRO CN7 palsy and comorbid traumatic injury
2. If hearing loss does no resolve in 3/12 and HL >30db, do CT temporal bone tro ossicular chain disruption
59
Mx of Ramsay Hunt Syndrome
Prednisolone, antivirals(acyclovir?), omeprazole. topical eye drops
60
Cx of Ramsay Hunt
1. Ear infections eg cellulitis, perichondritis
2. Corneal ulcer from exposure keratopathy
61
Invx for cholesteatoma
1. CT Temporal bone
2. Audiometry
62
Mx for cholesteatoma
Tympanomastoidectomy and ossicular chain reconstruction if indicated
63
Cx of cholesteatoma
1. Labyrinthitis
2. Meningitis, abscess, empyema
3. HL from ossicular chain dysruption
4. CN 7 palsy
5. Mastoiditis
64
How to tell if otoscopy shows L or R ear
Cone of light points to direction of that ear
65
Invx of case of Otitis Media with effusion
1. Audiometry
2. Tympanogram
3. Nasoendoscopy
66
Cx of otitis media with effusion
1. Mastoiditis
2. Meningitis
67
Mx of otitis media with effusion
1. Abx
2. TRO NPC
3. Grommet tube placement if does not resolve in 3/12
4. Early grommet placement if child with language delay
68
invx for TM perf from CSOM
1. Tympanogram
2. Audiometry
CT TB NOT needed
69
Mx of TM perf rom CSOM
1. Myringo/tympanoplasty if deos not get better
2. Aural toilet and abx if infected
70
Risk factors for otosclerosis
1. MIddle Aged
2. Female
3. Indian or caucasian
4. Lack of fluoride
5. FMHX strongest indicator
6. Genetic
7. Autoimmune predilection
71
Invx for suspected Otosclerosis
CT/MRI temporal bone tro other causes eg ossicular chain disruption, mass
72
mx of otosclerosis
1. Do nothing
2. Hearing aids
3. Exploratory tympanotomy with stapedotomy nad prosthesis
73
Mx of cerebellopontine tumor eg Acoustic Neuroma/Vestibular schwannoma or meningioma
Surgery +- RT
74
Tests for suspected Labyrinthitis
Audiometry and MRI IAM
75
Mx of sshl/sUDDEN SENSORINEURAL HEARING LOSS
1. PO prednisolone
2. Omeprazole
3. Hyperbaric O2 therapy
4. audiometry and IT dexamethasone if no improvement in 2/52
76
Olfactory tests
1. Upsit test
2. Sniffing sticks
77
what is FESS
Functional endoscopic sinus surgery
78
Sx of OSA in children
1. Restlessness
2. Abnormal sleeping posture
3. Laboured breathing
4. Paradoxical breathing
5. Nocturnal enuresis
6. Abnormal limb movements
79
What is AHI in OSA context
Apnea Hypopnea Index
80
ADHI severity for kids
1-5 mild
5-10 moderate
10< severe
81
First line surgical mx for child with OSA
Tonsillectomy and adenoidectomy
82
Most impt muscle related to a ranula
Myelohyoid dy/dx plunging and normal ranula
83
Mx of torus palate
Reassure and obsevration
84
Sx of SCC of the tongue
Tongue mass
Bleeding
Pain
Speech and mastication difficulties
Neck swelling
85
Risk factors for Oral/ tongue SCC
Smoking
Scalding water
Sharp Teeth
Sunlight
Substances eg betel nut
Immunosuppression
Radiation exposure
Prev Ca/dysplasia
86
Mx of tongue SCC
Wide local excision with neck dissection +- adjuvant RT
87
Cx of wide local excision of tongue SCC`
Neck aspiration of saliva
Bleeding
Problems with speech and swallowing
88
Invx, Mx and Cx of nasal dermoid
Invx: CT/MRI brain/sinus for intracranial extension
Mx: Complete surgical excision
Cx: CSF leak, Meningitis and deformity
89
Tests for CSF rhinorrhea/ otorrhea
Bedside: Looking for halo sign on gauze
Electrophoresis for beta 2 transferrin
90
Mx of Base of skull fracture
Surgical repair
Conservative: Head elevation, stool softeners, acetazolamide, lumbar drain, observe for 7 days
91
Contraindications to skin prick testing
1. Young child
2. Pregnancy
3. Severe uncontrolled asthma
4. Severe allergic rxns/ anaphylaxis
92
What is Chandler's classification for
Orbital cellulitis and its Cx
93
XR signs of button battery in child's nose
Stab sign on lateral skull XR
Halo sign on AP Skull XR
94
Cx of button battery in nose
Nasal septum perforation
Septal infection and abscess
Crusting and bleeding
95
Sx of Nasopharyngeal carcinoma
Blood in Sputum
LOA,LOW
Unilateral hearing Loss and otalgia due to OME
Unilateral nasal obstruction
Neck lumps
96
Invx for NPC
Biopsy via nasoendoscopy to confirm
MRI nasopharynx
PET CT
97
Most important risk factor for NPC
EBV infection
98
Mx of NPC
RT+- chemo
Surgery and neck dissection for recurrent local disease
99
Cx of NPC Mx
1.Risk of Carotid blowout
2 Vocal cord paralysis and bovine cough
3 Trismus( TMJ rigidity)
4 Neck muscle stiffness
5 Sinusitis
6 Atrophic rhinitis
7 CN palsy
8 Hearing loss, OME
9 Hypopituitarism
10 Secondary cancers
11 Dry mouth
100
Causes of laryngeal paillomatosis
HPV 6 and 11
101
Mx of laryngeal papillomatosis
1. Laser
2. Microdebrider
3. Cold steel surgery
4. anti VEGF injection
5. HPV vaccination
6. Systemic interferon therapy
102
Treatment for facial haemangiomas
PO propanolol
103
Syndrome associated with facial haemangiomas and main concern
PHACE(Pastrual Castroviejo), worried about subglottic airway haemangiomas
104
XR sign of acute epiglottitis
Thumb sign
105
ausative agent of epiglottitis
Haemophilus Influenzae B
106
Mx of epiglottitis
Secure airway
Send to ot ,intubation, if fail tracheostomy, cricothyroidotomy?
Telescope to railroad in larynx
Iv Abx, steroids, rescope for interval improvement,
Ct if persistent swelling tro abscess
Determine if patient requires hospitalisation
Stabilise the patient
107
Syndrome associated with medullary thyroid cancer
Multiple Endocrine Neoplasia Type 2(MEN 2)
