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N and airway Flashcards

(51 cards)

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1
Q

What is stridor?

A

A high pitched inspiratory noise

Due to laryngeal obstruction

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2
Q

What does stridor lead to?

A 
Can lead to respiratory distress
Tracheal tug (increased effort) 
Costal recession (using ribs to breathe)
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3
Q

Ways of dealing with someone with Stridor

A

Keep patient and parent of child calm
Oxygen via a mask
Adrenalin nebuliser - every 20minutes as needed - decongestant - blood vessels constrict and linings smaller
Steroids - dexamethasone IV or prednisolone Oral or budesonide nebuliser

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4
Q

If medical management of stridor fails what do you do?

A

Establish airway through the skin - emergency tracheostomy - but usually not needed

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5
Q

Congenital causes of stridor x3

A

Congenital subglottic stenosis
Larygnomalacia
Bilateral vocal cord palsy

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6
Q

What is congenital subglottic stenosis?

A

Narrow/small cricoid cartilage

With infection will swell and therefore further narrowing leads to croup in children

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7
Q

What is laryngomalacia?

A

“floppy larynx”
Like a tulip bulb that hasn’t completely opened yet
Normally better by 2 years of age

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8
Q

Management of laryngomalacia?

A

Anti-reflux because effort to breathe in can suck acid up oesophagus and cause reflux
Rarely still persistent - but if it is and too much effort to breathe with poor weight gain - can open it up surgically

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9
Q

Management of bilateral vocal cord palsy

A

Children need tracheostomy 50% of the time

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10
Q

Acquired causes of stridor

A
  • Trauma (blunt or endotracheal tube prolonged intubation in premature baby) leads to scarring therefore acquired subglottic stenosis
  • Burn
  • FB
  • Infection
  • Neoplastic
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11
Q

Tumour cause of stridor in children and adults

A

In children mostly benign papillomas

In adults mostly neoplastic malignant eg. squamous carcinoma

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12
Q

What is stertor?

A

Low pitch inspiratory sound due to pharyngeal obstruction

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13
Q

What is stertor when you have complete blockages

A

Apnoea

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14
Q

Commonest cause of stertor/obstructive sleep apnoea in children and adults

A

Child - adenoid and tonsil hypertrophy

Adult - raised BMI

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15
Q

Treatment of child stertor

A

Remove tonsils and adenoids

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16
Q

Treatment of adult stertor/sleep apnoea

A

Lose weight
Mandibular advancement splint
Mask with pressure from a machine at night to hold airway open - CPAP

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17
Q

What is nose lined with?

A

Pseudostratified ciliated columnar epithelium

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18
Q

Associated features of nasal obstruction

A

Itching, sneezing, rhinorrhoea, epiphora (watery eye)
Purulence, facial pain, anosmia, postnasal drip
Blood discharge and pain

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19
Q

Significant history for nasal obstruction

A

Asthma
Previous surgery or trauma
Smoking
Pregnancy

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20
Q

Cancer red flags with nasal obstruction

A 
Persistent unilateral obstruction 
Bloody discharge 
Persistent pain 
Weight loss 
Cervical LN 
>50 years 
Woodworker - resins within hard woods are particularly irritant to nose and have been shown to be carcinogenic 
Previous polyps
Teenage boy with epistaxis
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21
Q

What is rhinomanometry

Study These Flashcards
A

Tests of nasal airflow - nasal inspiratory peak flow

22
Q

4 congenital causes of nasal obstruction

Study These Flashcards
A

Choanal atresia
Dermoid cyst
Meningoencephalocoele
Structural deformity

23
Q

What is choanal atresia and how treated

Study These Flashcards
A

Opening from back of nose into nasopharynx hasn’t developed yet
Treated by putting a hole in the atresic plate

24
Q

What is a dermoid cyst and how treated

Study These Flashcards
A

Cyst under the skin

Treated surgically

25
What is meningoencephalocoele
Defect in skull base and brain comes down and causes obstruction
26
Acquired causes of nasal obstruction
Trauma | Infective is rare but can get septal abscess
27
What is a septal haematoma
Cherry red swelling bilaterally in the nose - pericondrium is stripped off the septal cartilage and if its not addressed in first 24hours - will lose septal cartilage
28
Inflammatory causes of nasal obstruction
Allergic rhinitis Rhinosinusitis Adenoiditis Vasculitis
29
What is allergic rhinitis and how do you treat it?
Inflammation caused by airborne pathogen Identify allergen and avoid it Can also use topical steroids and/or antihistamines Oral antihistamines if severe
30
What is rhinosinusitis?
Sinusitis is an infection of paranasal sinuses Usually bacterial Most commonly associated with URTI but can occur with asthma
31
Symptoms of rhinosinusitis?
Frontal headache Purulent rhinorrhoea Facial pain with tenderness Fever
32
Treatment of rhinosinusitis
Nasal douching Topical nasal steroids Lose dose antibiotics If polyps - oral steroids and polypectomy
33
What is adenoiditis
Inflammation of adenoid tissue at the back of the nose - often a pus-like discharge from the nose
34
Upper midline neck lump
Thyroglossal cyst Dermoid cyst Lymph nodes
35
Lower midline neck lump
Thryoid gland mass | Lymph nodes
36
Upper lateral neck lump
Salivary gland Neurogenic and vascular neoplasms Lymph nodes
37
Lower lateral neck lump
Lymph nodes
38
Under 20 with a neck lump
Congenital inflammatory lymphomas
39
20-40 years old neck lump
Branchial cyst Salivary gland Thyroid neoplasm
40
over 40 neck lump
Malignant neoplasm | ANY Lateral neck lump in adult >40 is malignant until proven otherwise
41
What is a branchial cyst
``` 2nd arch abnormality Usually after URTI Patients 15-20 Usually painless Treatment is surgical ```
42
How can you tell it is thryoglossal duct cyst
Will move with swallowing
43
What is warthins tumour?
A benign tumour of the parotid gland
44
Medication which can cause epistaxis?
``` Warfarin Heparin Aspirin Clopidogrel Dabigatran, rivaroxaban, apixaban Garlic ```
45
Initial management of epistaxis?
``` ABC IV access and bloods Pressure and ice pack Control HTN Correct coagulopathies (FFP, whole blood, platelets, reverse anticoagulant) Topical decongestants/vasoconstrictors Cautery Nasal packing ```
46
Surgical treatment of epistaxis?
Artery ligation Embolization - if still bleeding after ligation or bleeding site difficult to reach - or comorbities which prohibit GA - only effective when bleeding
47
What is Samters triad
Triad of asthma, aspirin sensitivity and nasal polyps
48
Management of Nasal polyps
Topical corticosteroids
49
When do nasal polyps require further ENT investigation
Unilateral or epistaxis
50
Management of allergic rhinosinusitis
Loratadine Systemic decongestants - pseudoephedrine Sodium chromoglicate nasal spray Beclometasone steroid nasal spray
51
Presentation of retropharyngeal abscess
Ill child with stiff, extended neck/torticollis who fails to eat or drink Manage with incision and drainage

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