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Family Medicine > Common ENT > Flashcards

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
Q

Treatment of choice for persistent\recurrent GAS pharyngitis:

A
  • Augmentin

- Cephalaxin

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26
Q

Most characterstic radiological sign of epiglottis

A

Thumb sign

27
Q

Most common infectious agent in epiglotitis is:

A

Hemphohillus influnza

28
Q

Presentation of epiglottis is:

A
  • stridor
  • drooling
  • respiratory distress
  • sniffing position
  • fever
29
Q

How to treat epiglottis?

A
  • stabilize airway
  • emperic Ab
  • Cephtriaxone
  • Vancomycin
30
Q

Anterior VS posterior chain of lymph nodes infections :

A

Anterior enlargement: GAS

Posterior enlargement: IM

31
Q

Most common organism to cause IM:

A

EBV

32
Q

Clinical presentation of IM:

A

1- Lymphadenopathy
2- Fever, fatigue, phyaryngitis.
3- palatal Petechia
4- splenomegaly (Splenic rupture)

33
Q

Investigations that must be run before diagnosing IM:

A
  • WBC count w\differential
  • Monospot
  • Culture\RADT: rule out GAS
34
Q

How to treat IM:

A

Symptomatic relief.

35
Q

When can athletes resume non-contact sport after they get infected with IM?

A

After 3 weeks of symptoms relief

36
Q

What do you expect to see following Ab therapy in IM?

A

Maculopapular rash.

37
Q

How is IM transmitted.

A

Saliva

38
Q

What are red flags for dizziness?

A

1- Falls
2- Hemiparesis
3- Visual\speech changes

39
Q

How is vertigo described?

A

(Self-motion)

  • Distorted self-motion when normal movement.
  • Self-motion when staying still
40
Q

Describe the difference between changing positions in BPPV and orthrostatic hypotension:

A
  • BPPV: Turning head - back head in shower

- Orthostatic: upright changes

41
Q

What is the triad in menniere’s disease?

A
  • Vertigo
  • Senseri-neural hearing loss
  • Tinnitus\fullness
42
Q

What important examinations should be preformed in dizziness?

A 
1- supine-standing BP
2- Gait for neurology 
3- Otoscopy 
4- Dix hallpike 
5- Rinne’s & webber.
43
Q

When to order imaging for patients with vertigo?

A

Asymmetrical\Unilateral hearing loss.

44
Q

How is the vertigo in meniere’s disease described?

A

Severe - necessitate bed rest - associated w\nausea, vomiting, loss of balance, Nystagmus.

45
Q

How to treat meniere’s disease?

A
  • Pharmacological: Thiazide diuretics —> surgery if refractory.
  • Non-pharmacological: Salt\Alcohol\Coffee restriction
46
Q

Loose canaliths usually enter which canal in BPPV:

A

Posterior canal

47
Q

Most common cause of BPPV in old and young patients?

A

Old: Uknown
Young: head falls

48
Q

Treatment of BPPV:

A

Epley’s maneuver only. No vestibular suppressants

49
Q

Differentiate between Dix-hallpike and Epley maneuvers

A

Dix: Diagnosis
Epley: treatment

50
Q

How to make diagnosis of otitis media:

A

1- [Mod\sev] Bulging + Otorrhea.

2-[Mild] + Pain or erythema.

51
Q

How to manage patients w\otitis media?

A

1- Analgesics especially in pediatric before bed time (to avoid sleep disturbance)
2- Ab OR observation

52
Q

How to determine severity in AOM?

A
  • Pain >48hours

- Temp >39

53
Q

How to observe for AOM?

A

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
Q

Treatment of choice for AOM for children:

A

[1]- Amoxycillin High does [80-90\Kg] divided on 2 doses for 10 days.

55
Q

When to opt for Augmentin instead of amoxycillin in AOM in children?

A

In:

  • conjunctivitis
  • taken Amoxycillin in past 30 days
  • Need B-lactamase coverage
56
Q

How to prevent recurrent AOM in children?

A
  • Avoid pacifier\Smoke
  • look for allergies
  • immunize against (influnza + Pneumococcal)
57
Q

How to treat Adult AOM?

A

Augmentin for 5-7days if not severe - 10 days if severe.

58
Q

When to refer patients with AOM in adults?

A
  • Recurrent
  • Perforated
  • Hearing loss
59
Q

When to consider AOM recurrent in Adults?

A

More than 2 times\6months.

60
Q

Risk factors for allergic rhinitis include:

A

.

61
Q

Clinical presentation of allergic rhinitis is:

A
  • -
62
Q

Examination in allergic rhinitis include:

A

-

63
Q

How to confirm allergic rhinitis?

A

Based on allergy skin test for 48 hours, but not necessary

64
Q

Treatment of allergic rhinitis

A

Corticosteroid spray

Family Medicine (15 decks)

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