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Common ENT Flashcards

1
Q

What is the most common causes for otitis externa

A

Bacterial causes (Pseduomonas + S. Aureus)

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2
Q

What are the risk factors for otitis Externa?

A

1- Swimming
2- Eczema\Seborrhea
3- Trauma (Cerumen removal)
4- Devices (hearing aid)

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3
Q

What are the clinical signs & symptoms associated with otitis externa?

A

Symptoms
1- Pain
2- pruritus
3- Hearing loss

Signs: 
4- Discharge (yellow, brown, white, grey) 
5- trargal pressure tenderness 
6- erythematous TM
7- canal edema not showing full TM
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4
Q

How is the diagnosis of otitis externa usually made?

A

Clinically

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5
Q

Explain non-pharamacological management of otitis externa:

A

1- properly administer medication
2- avoid water for a week\ avoid submersion\ avoid ear phones or hearing aids\avoid foreign objects
3- use cotton coated petroleum jelly when bathing
4- if competitive return after 2-3d after pain cessation while using fitted wear plugs

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6
Q

Treatment of choice for otitis externa with intact tympanic membrane & no amino glycoside sensitivity

A

[Topical]

1- Neomycin
2- polymyxin
3- hydrocortisone

For 7-10 days

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7
Q

Treatment of choice for otitis externa with perforated tympanic membrane & amino glycoside sensitivity

A

[Topical]

1-Ciproflaxacin\oflaxacin
2- Dexamethasone

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8
Q

When to opt for oral antibiotic in patients with otitis externa?

A

1- infection spread beyond ear
2- DM & immunocompromised
3- Local radiotherapy
4- inability to deliver topical AB

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9
Q

When to refer patients with otitis externa?

A

Malignant otitis externa

invasion from external auditory canal to skull base, caused by pseudomonas, commonly seen in elderly w\DM

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10
Q

When to expect improvement after otitis externa treatment?

A

2-3 days

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11
Q

What if after 2-3 days from otitis externa, symptoms still presist?

A

1- misdiagnosis or misuse of medics
2- sensitivity to ear drops (consider culture)
3- canal patency.

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12
Q

What to expect to see in otitis media otoscopic examination

A

1- bulging
2- airfluid levels (otorrhea)
3- erythema

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13
Q

What are the most common organism to cause otitis media?

A

1- strep pneumonia
2- Hemophillus influnza
3-moroxhella catarahlis

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14
Q

impaired function of eustachian tube is associated with which type of otitis?

A

Otitis media

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15
Q

Name risk factors for otitis media

A 
1- young \exposure to day care 
2- pacifier use\ no breast feeding 
3- immunocompromised 
4- familial 
5- allergies \ GERD
 6- craniofascial abnormalities 
7- respiratory irritant 
8- respiratory infection
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16
Q

What conditions do nasal polyps associate with?

A

1- bronchial asthma
2- Rhino-sinusitis
3- aspirin sensitivity

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17
Q

Symptoms of large nasal polyps:

A

1- blockage
2- thick mucus (rhinorrhea)
3- anosmia

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18
Q

First line treatment of nasal polyps:c

A

Nasal corticosteroid spray > still symptomatic? Surgery

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19
Q

Modified centor criteria include:

A

1- tonsillar exudate\swelling
2- absences of cough
3- temp >38
4- Swollen ant. Lymph nodes

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20
Q

The most common
Virus - Bacteria
To cause pharyngitis:

A
  • Virus: Respiratory (adeno,rhino,coronavirus)

- Bacteria: GAS

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21
Q

What are the complications of GAS infection?

A
  • Suppurative: peritonsillar abscess, meningitis, bacteremia, otitis media, necrotizing fascitis
  • Non-suppurative: Post-streptococcal glomerulonephritis - reactive arthritis - Rhumatic fever
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22
Q

What is your next step after identifying centor criteria in:

  • Score 0-1
  • Score 2-3
  • Score >4
A

1- No test\Ab
2- Throat culture\RADT > Ab if +ve
3- Empiric Ab.

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23
Q

What recommendations would you give patients after diagnosing viral pharyngitis?

A

1- Rest & hydrate
2- Acetaminophen\asprin\NSAID
3- Food that coat throat (Honey)
4- Avoid smoke\dryness\Ab

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24
Q

Treatment of choice for GAS pharyngitis:

A

Penicillin 500mg 2\3x for 10d.

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25
Treatment of choice for persistent\recurrent GAS pharyngitis:
- Augmentin | - Cephalaxin
26
Most characterstic radiological sign of epiglottis
Thumb sign
27
Most common infectious agent in epiglotitis is:
Hemphohillus influnza
28
Presentation of epiglottis is:
- stridor - drooling - respiratory distress - sniffing position - fever
29
How to treat epiglottis?
- stabilize airway - emperic Ab - Cephtriaxone - Vancomycin
30
Anterior VS posterior chain of lymph nodes infections :
Anterior enlargement: GAS | Posterior enlargement: IM
31
Most common organism to cause IM:
EBV
32
Clinical presentation of IM:
1- Lymphadenopathy 2- Fever, fatigue, phyaryngitis. 3- palatal Petechia 4- splenomegaly (Splenic rupture)
33
Investigations that must be run before diagnosing IM:
- WBC count w\differential - Monospot - Culture\RADT: rule out GAS
34
How to treat IM:
Symptomatic relief.
35
When can athletes resume non-contact sport after they get infected with IM?
After 3 weeks of symptoms relief
36
What do you expect to see following Ab therapy in IM?
Maculopapular rash.
37
How is IM transmitted.
Saliva
38
What are red flags for dizziness?
1- Falls 2- Hemiparesis 3- Visual\speech changes
39
How is vertigo described?
(Self-motion) - Distorted self-motion when normal movement. - Self-motion when staying still
40
Describe the difference between changing positions in BPPV and orthrostatic hypotension:
- BPPV: Turning head - back head in shower | - Orthostatic: upright changes
41
What is the triad in menniere’s disease?
- Vertigo - Senseri-neural hearing loss - Tinnitus\fullness
42
What important examinations should be preformed in dizziness?
``` 1- supine-standing BP 2- Gait for neurology 3- Otoscopy 4- Dix hallpike 5- Rinne’s & webber. ```
43
When to order imaging for patients with vertigo?
Asymmetrical\Unilateral hearing loss.
44
How is the vertigo in meniere’s disease described?
Severe - necessitate bed rest - associated w\nausea, vomiting, loss of balance, Nystagmus.
45
How to treat meniere’s disease?
- Pharmacological: Thiazide diuretics —> surgery if refractory. - Non-pharmacological: Salt\Alcohol\Coffee restriction
46
Loose canaliths usually enter which canal in BPPV:
Posterior canal
47
Most common cause of BPPV in old and young patients?
Old: Uknown Young: head falls
48
Treatment of BPPV:
Epley’s maneuver only. No vestibular suppressants
49
Differentiate between Dix-hallpike and Epley maneuvers
Dix: Diagnosis Epley: treatment
50
How to make diagnosis of otitis media:
1- [Mod\sev] Bulging + Otorrhea. | 2-[Mild] + Pain or erythema.
51
How to manage patients w\otitis media?
1- Analgesics especially in pediatric before bed time (to avoid sleep disturbance) 2- Ab OR observation
52
How to determine severity in AOM?
- Pain >48hours | - Temp >39
53
How to observe for AOM?
Wait for 48-72 hours, if no change in symptoms, prescribe Ab. If rural or can’t come to the appt, give them backup or initiate it.
54
Treatment of choice for AOM for children:
[1]- Amoxycillin High does [80-90\Kg] divided on 2 doses for 10 days.
55
When to opt for Augmentin instead of amoxycillin in AOM in children?
In: - conjunctivitis - taken Amoxycillin in past 30 days - Need B-lactamase coverage
56
How to prevent recurrent AOM in children?
- Avoid pacifier\Smoke - look for allergies - immunize against (influnza + Pneumococcal)
57
How to treat Adult AOM?
Augmentin for 5-7days if not severe - 10 days if severe.
58
When to refer patients with AOM in adults?
- Recurrent - Perforated - Hearing loss
59
When to consider AOM recurrent in Adults?
More than 2 times\6months.
60
Risk factors for allergic rhinitis include:
.
61
Clinical presentation of allergic rhinitis is:
- - - -
62
Examination in allergic rhinitis include:
- - -
63
How to confirm allergic rhinitis?
Based on allergy skin test for 48 hours, but not necessary
64
Treatment of allergic rhinitis
Corticosteroid spray

Family Medicine (15 decks)

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