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CMN 568 > Ch. 8 Adult ENT (E1) > Flashcards

Ch. 8 Adult ENT (E1) Flashcards

1
Q

3 types of hearing tests

A

Whisper
Weber
Rinne

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2
Q

Cerumen Impaction treatment

A

Detergent ear drops (3% hydrogen peroxide or 6.5% carbamide peroxide)

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3
Q

when should irrigation be performed with cerumen impaction

A

when the tympanic membrane is known to be intact

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4
Q

“swimmers ear”

A

otitis externa

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5
Q
  • Presents with otalgia with associated external auditory canal edema and purulent discharge
  • Surrounding periauricular cellulitis
  • Pain with manipulation of the auricle
    -When the canal skin is very edematous, may be impossible to visualize the tympanic membrane
A

Otitis Externa

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6
Q

osteomyelitis of the skull base seen in immunocompromised patients

A

malignant otitis externa

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7
Q

treatment of otitis external with cellulitis of the periauricular tissue

A

ciprofloxacin (fluroquinolones are affective against pseudomonas)

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8
Q

what should be suspected if otitis externa does not resolve with therapy

A

malignancy, need biopsy

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9
Q

connects the middle ear to the nasopharynx and provides ventilation and drainage for the middle ear

A

Eustachian tube

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10
Q

when is the Eustachian tube normally closed

A

yawning and swallowing

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11
Q

most common causes of Eustachian tube dysfunction

A

viral URI and seasonal allergies

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12
Q

c/o sense of fullness in the ear and mild to moderate impairment of hearing
and Popping or crackling sound with swallowing or yawning

A

Eustachian tube dysfunction

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13
Q

what do you expect to find on an exam with Eustachian tube dysfunction

A

retraction of the tympanic membrane

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14
Q

treatment of Eustachian tube dysfunction

A

systemic and intranasal decongestants (pseudoephedrine & oxymetazoline)

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15
Q

Typically occurs with an upper respiratory tract infection, with barotrauma or with chronic allergic rhinitis.

A

Serous Otitis Media

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16
Q

examination results:
- Tympanic membrane is dull and hypomobile
- conductive hearing loss

A

Serous otits media

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17
Q

treatment of serous otitis media

A

Oral corticosteroids (Prednisone 40mg x7days)
Oral antibiotics (Amoxicillin 250 TID x 7days)

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18
Q

treatment of barotrauma

A

oral and topical decongestants (pseudoephedrine 60-120mg, 1% phenylephrine or oxymetazoline nasal spray)

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19
Q

what is an absolute contraindication to diving

A

tympanic membrane perforation

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20
Q

bacterial infection of the mucosally lined, air-containing spaces of the middle ear

A

acute otitis media

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21
Q

s/s
- otalgia
-aural pressure
- decreased hearing
- fever

A

Acute otitis media

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22
Q

Examination results
- erythema
- decreased mobility of the tympanic membrane
- occasional bullae on tympanic membrane

A

acute otitis media

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23
Q

dx
- pain, postauricular erythema, and occasionally proptosis of the auricle.
- Frank swelling over the mastoid bone or the association of cranial neuropathies or central findings indicates severe disease

A

acute mastoiditis

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24
Q

treatment of acute otitis media

A

amoxicillin 1g PO q8 x5-7 days

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25
Q

recurrent acute otitis media can cause —

A

chronic otitis media

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26
Q

Examination results:

  • Perforation or retraction of the tympanic membrane may be present
  • Purulent aural discharge
  • Increased draining with upper respiratory infection or following water exposure
  • No c/o pain
  • conductive hearing loss from destruction of the tympanic membrane or ossicular chain
A

Chronic otitis media

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27
Q

treatment of chronic otitis media

A

oflaxacin or ciprofloxacin with dexamethasone drops

(oral cipro if fighting psudomonas)

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28
Q

most common intracranial complication of ear infections

A

otogenic meningitis

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29
Q

tympanic membrane perforation may occur from

A

impact injury or explosive acoustic trauma

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30
Q

ototoxic substances that can cause irreversible hearing loss in therapeutic doss (3)

A

aminoglycosides
loop diuretics
antineoplastic agents (Cisplantin)

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31
Q

what is it important to avoid with a perforated tympanic membrane

A

ototoxic ear drops (neomycin, gentamycin)

32
Q

treatment:
c/o –>
sudden loss of hearing in one ear
aural fullness
tinnitus
dizziness

A

corticosteroids (intratympanic and oral)

33
Q

excessive sensitivity to sound after hearing loss

A

hyperacusis

34
Q

__ is the cardinal symptom of vestibular disease

A

vertigo

35
Q

dx s/s:
sudden onset of severe vertigo (inability to stand/walk)
N/V
tinnitus and hearing loss

A

peripheral vestibular disease

36
Q

2 types of vertigo testing

A

Dix hallpike and Fuduka

37
Q

singular vertigo attack without accompanying impairment of auditory function and persists for several days before going away

A

vestibular neuronitis

38
Q

treatment for vestibular neuronitis

A

Diazepam (vestibular suppressant)
Oral corticosteroids

39
Q

vertigo triggered by neck movements

A

cervical proprioceptive dysfunction

40
Q

dx: c/o
head pressure, visual/motion/auditory sensitivity, photosensitivity
symptoms worsen with lack of sleep or stress/anxiety

A

Migrainous vertigo

41
Q

__ resembles meunière disease but without hearing loss or tinnitus

A

Migrainous vertigo

42
Q

lesions of the ___ can produce hearing loss and dizziness

A

8th cranial nerve and central audiovestibular pathways

43
Q

DX:

c/o unilateral hearing loss with a deterioration of speech discrimination exceeding that predicted by the degree of pure-tone loss

A

Vestibular Schwannoma (Acoustic Neuroma)

44
Q

ANY UNILATERAL OR ASYMMETRIC SENSORINEURAL HEARING LOSS SHOULD BE EVALUATED FOR ___

A

AN INTRACRANIAL MASS LESION

45
Q

__ can lead to acute bacterial sinusitis and acute otitis media, asthma, cystic fibrosis, and

A

Viral rhinosinusitits

46
Q

Nasal examination shows:
- Erythematous, edematous mucosa and a watery discharge.

A

Viral rhinosinusitis

47
Q

treatment for viral rhinosinusitis

A

psudoephederine
OTC analgesics
rest and hydration

48
Q

persistence of acute viral rhinitis beyond 10 days with purulent green or yellow nasal secretions and unilateral facial or dental pain

A

secondary acute bacterial rhinosinusitis

49
Q

c/o

  • Acute onset of symptoms
  • Purulent, yellow/green nasal discharge or expectoration
  • Facial pain or pressure over the affected sinus or sinuses
  • Nasal obstruction
  • Associated cough, malaise, fever, and headache
A

bacterial rhinosinusitis

50
Q

most common form of bacterial rhinosinusitis

A

acute maxillary sinusitis

51
Q

when and how do you treat bacterial rhinosinutistis

A

treat symptoms lasting >10 days or when symptoms include fever, facial pain, and swelling of the face

treat with intranasal corticosteroids and antibiotcs

52
Q

dx s/s:

  • extreme facial pain
  • clear/straw colored nasal drainage
  • black eschar on the middle turbinate (not always visible)
  • pale and dry mucosa
A

invasive fungal sinusitis

53
Q

dx physical exam findings

  • Mucosa is pale or violaceous
  • Nasal polyps that are yellowish boggy masses of hypertrophic
A

allergic rhinitis

54
Q

treatment of allergic rhinitis

A
  • intranasal corticosteroids (Beclomethasone, Flunisolide, Mometasone furoate, Budesonide, Fluticasone propionate)
  • antihistamines (Loratadine, Desloratadine, Fexofenadine, Cetirizine)
  • antileukotriene (Montelukast/cromolyn sodium)
55
Q

a white plaque-like lesion that can not be removed by rubbing the mucosal surface

A

Leukoplakia

56
Q

Early lesions appear as leukoplakia or Erythroplakia; more advanced lesions will be larger, painful, and can involve the tongue, gums, hard palate, inner lining of the lips or cheek. Ulceration may be present

A

Oral cancer

56
Q

Most commonly presents as lacy leukoplakia but may be erosive; definitive diagnosis requires biopsy

A

Oral lichen planus

57
Q

Similar to leukoplakia except that it has a definite erythematous component

A

erythroplakia

58
Q

treatment of hair leukoplakis

A

acyclovir, valacyclovir, and famciclovir

59
Q

dx: s/s

  • painful
  • white areas are easily rubbed off (unlike leukoplakia or lichen planus)
  • angular cheilitis (also seen in nutritional deficiencies)
A

Oral candidiasis (thrush)

60
Q

treatment of oral candidiasis (thrush)

A

Fluconazole, Ketoconazole, Nystatin rinses

61
Q

a red, smooth-surfaced tongue s/t inflammation of the tongue with loss of filiform papillae

A

Glossitis

62
Q

dx: s/s

  • Burning and pain of the tongue – may occur with or without glossitis
  • “burning mouth syndrome”
  • Benign – no infection
A

glossodynia

63
Q

Dx: S/S

  • painful acute gingival inflammation and necrosis
  • bleeding
  • halitosis
  • fever
  • cervical lymphadenopathy
A

Ulcerative Gingivitis (Trench mouth, Vincent Angina)

64
Q

treatment for Ulcerative Gingivitis (Trench mouth, Vincent Angina)

A

oral PCN and warm half-strength peroxide rinses

65
Q

Appear as painful small round ulcerations with yellow-gray fibrinoid centers surrounded by red halos

A

Aphthous Ulcer (Canker Sore, Ulcerative Stomatitis)

66
Q

treatment of Aphthous Ulcer (Canker Sore, Ulcerative Stomatitis)

A

Topical corticosteroids for symptom relief and Cimetidine for maintenance therapy

67
Q

dx: s/s

  • fever or 38C
  • tender anterior cervical adenopathy
  • lack of a cough
  • pharyngotonsillar exudate
A

Group A streptococcal pharyngitis

68
Q

dx: s/s

Marked lymphadenopathy; shaggy, white-purple tonsillar exudate

A

mononucleosis

69
Q

if mono is suspected, which antibiotic should be avoided

A

ampicillin

70
Q

how to diagnosis Group A streptococcal pharyngitis

A

single saw throat culture or rapid antigen detection testing

71
Q

what is the centor criteria for group A streptococcal pharyngitis

A

exudate or swelling on tonsils, anterior cervical adenopathy, fever, lack of cough

0-1 - no testing or antibiotics necessary
2-3- testing needed to determine antibiotics
all 4- no testing needed, prescribe antibiotics

72
Q

treatment for Group A streptococcal pharyngitis

A

PO antibiotics– PCN V potassium, cefuroxime axetil or amoxicillin

clindamycin, erythromycin, or azithromycin for PCN allergy patients

73
Q

Treatment for mild peritonsillar abscesses and cellulitis

A

amoxicillin, augmentin, or clindamycin x 7-10 days

74
Q

treatment for Ludwig angina

A

PCN + metronidazole
ampicillin-sulbactam
clindamycin
selective cephalosporins

CMN 568 (3 decks)

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