DISORDERS OF ENT (NELSONS)

Question 1

What is otitis externa?

Answer 1

An infection of the external auditory canal, commonly related to water exposure, often occurring in warm, humid climates.

Question 2

What age group has the highest annual rates of ambulatory care visits for acute otitis externa in the U.S.?

Answer 2

5-9 year-olds, followed by 10-14 year-olds.

Question 3

What are the most common bacterial pathogens in otitis externa?

Answer 3

Pseudomonas (32%) and Staphylococcus aureus (21%).

Question 4

What is the most common fungal pathogen in otitis externa?

Answer 4

Aspergillus (20%).

Question 5

What are the clinical manifestations of localized otitis externa?

Answer 5

Pain on pinna manipulation, redness, swelling of the canal, with or without purulent discharge.

Question 6

What is the first-line treatment for otitis externa?

Answer 6

Topical antibiotics, insertion of ear wicks with antibiotics or povidone iodine, and analgesics.

Question 7

What did the Cochrane Systematic Review reveal about treating otitis externa?

Answer 7

Topical antimicrobials with steroids are more effective than placebo; acetic acid is effective only in the first week.

Question 8

What is otitis media?

Answer 8

A spectrum of diseases including acute otitis media, recurrent otitis media, otitis media with effusion, and chronic otitis media.

Question 9

What is the prevalence of otitis media in the Philippines?

Answer 9

12%, the highest among Asia-Pacific countries.

Question 10

What percentage of children experience acute otitis media (AOM) by age 3?

Answer 10

20% experience at least one episode, with incidence peaking at 6-11 months.

Question 11

What are the most common bacterial pathogens in acute otitis media (AOM)?

Answer 11

Streptococcus pneumoniae, non-typeable Haemophilus influenzae, and Moraxella catarrhalis.

Question 12

What are the otoscopic findings in acute otitis media?

Answer 12

Erythema of the drum, bulging drum, air-fluid levels, or perforation with otorrhea.

Question 13

What is the recommended first-line antibiotic for acute otitis media in the Philippines?

Answer 13

Amoxicillin.

Question 14

What preventive measures can reduce the risk of acute otitis media?

Answer 14

Breastfeeding for 6 months, upright feeding position, and avoiding tobacco smoke exposure.

Question 15

What is otitis media with effusion (OME)?

Answer 15

Presence of fluid behind an intact eardrum without acute signs of inflammation.

Question 16

What are the otoscopic findings in otitis media with effusion?

Answer 16

Air-fluid levels and impaired mobility of the eardrum.

Question 17

When is surgical intervention recommended for otitis media with effusion?

Answer 17

Persistent bilateral OME for 3 months with hearing loss of 25-30 dB or worse.

Question 18

What is chronic otitis media (COM)?

Answer 18

A condition characterized by discharge through a perforated drum lasting longer than 2 weeks.

Question 19

What are the most common bacterial pathogens in chronic otitis media in the Philippines?

Answer 19

Staphylococcus aureus and Pseudomonas.

Question 20

What are the extracranial complications of chronic otitis media?

Answer 20

Facial paralysis, labyrinthitis, petrositis, and subperiosteal abscess.

Question 21

What are the intracranial complications of chronic otitis media?

Answer 21

Meningitis, brain abscesses, lateral sinus thrombosis, and hydrocephalus.

Question 22

What is the first-line treatment for chronic otitis media with discharge?

Answer 22

Topical quinolone antibiotics.

Question 23

What surgical interventions are used for chronic otitis media?

Answer 23

Mastoidectomy combined with ossicle or tympanic membrane reconstruction.

Question 24

Define acute rhinosinusitis in children according to EPOS.

Answer 24

The sudden onset of 2 or more symptoms: nasal blockage/obstruction/congestion, discolored nasal discharge, and daytime and nighttime cough of less than 12 weeks’ duration.

Question 25

What is the most common etiology of acute rhinosinusitis?

Answer 25

Acute rhinosinusitis is usually infectious in etiology.

Question 26

What are the most common pathogens in Filipino children with acute bacterial rhinosinusitis?

Answer 26

Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus.

Question 27

What percentage of patients with acute bacterial rhinosinusitis have mixed isolates?

Answer 27

64% of patients.

Question 28

What is the most common combination of pathogens in Filipino children with acute bacterial rhinosinusitis?

Answer 28

Streptococcus pneumoniae and Haemophilus influenzae.

Question 29

What percentage of patients with a cold develop viral sinusitis?

Answer 29

90% of patients with a cold develop viral sinusitis.

Question 30

What percentage of individuals with viral sinusitis develop acute bacterial sinusitis?

Answer 30

0.5%-2%.

Question 31

What are the IDSA criteria for diagnosing bacterial rhinosinusitis?

Answer 31

Persistent signs/symptoms lasting 10+ days without improvement, severe symptoms (high fever, purulent nasal discharge, facial pain) lasting 3-4 days, or worsening symptoms (new fever, headache, increased nasal discharge) in an initially improving viral URI.

Question 32

When is radiologic examination recommended for rhinosinusitis diagnosis in children?

Answer 32

In cases unresponsive to medical therapy or with worsening symptoms.

Question 33

What is the IDSA-recommended first-line treatment for non-severe acute bacterial rhinosinusitis in children?

Answer 33

Amoxicillin-clavulanate.

Question 34

What is the recommended empiric therapy for regions with high rates of invasive penicillin non-susceptible Streptococcus pneumoniae?

Answer 34

High-dose amoxicillin-clavulanate.

Question 35

What antibiotics are not recommended for empiric therapy in rhinosinusitis due to resistance?

Answer 35

Macrolides and trimethoprim-sulfamethoxazole.

Question 36

What evidence supports the use of saline nasal irrigation in rhinosinusitis?

Answer 36

It alleviates symptoms, improves endoscopic findings, and improves quality of life.

Question 37

What is acute pharyngotonsillitis?

Answer 37

An inflammatory condition of the pharynx and tonsils with symptoms like sore throat, dysphagia, odynophagia, fever, and enlarged tender cervical lymph nodes.

Question 38

What is the most common bacterial cause of pharyngotonsillitis?

Answer 38

Group A Streptococcus pyogenes (GABHS).

Question 39

What complications can arise from GABHS pharyngotonsillitis?

Answer 39

Suppurative complications (e.g., cervical adenitis, abscesses) and non-suppurative complications (e.g., rheumatic fever, acute glomerulonephritis).

Question 40

What are the IDSA-recommended antibiotics for GABHS tonsillopharyngitis?

Answer 40

Amoxicillin or phenoxymethylpenicillin for 10 days, or a single intramuscular injection of benzathine penicillin G.

Question 41

What is peritonsillar abscess also known as?

Answer 41

Quinsy.

Question 42

What are hallmark signs of peritonsillar abscess?

Answer 42

Fullness of the anterior tonsillar pillar, uvular deviation away from the abscess, 'hot potato' voice, and trismus.

Question 43

What is the first-line antibiotic treatment for peritonsillar abscess?

Answer 43

Penicillin targeting Streptococcus species.

Question 44

What surgical procedures are used to treat peritonsillar abscess?

Answer 44

Needle aspiration, incision and drainage, and immediate tonsillectomy.

Question 45

What complications can arise from untreated peritonsillar abscess?

Answer 45

Spread of infection to the carotid sheath, deep spaces of the neck, and mediastinum.

Question 46

What virus most commonly causes infectious mononucleosis (IM)?

Answer 46

Epstein-Barr virus (EBV).

Question 47

What age group is most commonly affected by infectious mononucleosis in the U.S.?

Answer 47

Individuals between 15 and 19 years old.

Question 48

How is Epstein-Barr virus (EBV) most commonly spread?

Answer 48

Through contact with saliva, such as kissing or sharing feeding utensils.

Question 49

What is the incubation period for infectious mononucleosis?

Answer 49

30-50 days.

Question 50

What are the hallmark symptoms of infectious mononucleosis?

Answer 50

Sore throat, fever, swollen glands, and pus on the tonsils.

Question 51

What lab finding is most frequent in infectious mononucleosis?

Answer 51

Atypical lymphocytosis with atypical mononuclear cells in the peripheral blood.

Question 52

Which antibody test is more reliable for diagnosing primary EBV infection than heterophile antibodies?

Answer 52

EBV nuclear antigen I (EBNA-I) IgG antibodies.

Question 53

Is there a standard treatment for the acute pharyngitis of infectious mononucleosis?

Answer 53

No, but corticosteroids are sometimes used for faster symptom relief.

Question 54

What is the typical clinical presentation of acute epiglottitis?

Answer 54

High fever, sore throat, dyspnea, and rapidly progressive respiratory obstruction.

Question 55

What organism most commonly causes acute epiglottitis?

Answer 55

Haemophilus influenzae type B (HiB).

Question 56

What classic position do children with acute epiglottitis often assume?

Answer 56

The tripod position (upright sitting, leaning forward, mouth open).

Question 57

What is the thumb sign on a lateral neck X-ray indicative of?

Answer 57

A swollen epiglottis, suggestive of acute epiglottitis.

Question 58

What is the treatment priority for suspected acute epiglottitis?

Answer 58

Immediate airway maintenance and culture-guided antimicrobial therapy.

Question 59

What virus is the most common cause of laryngotracheobronchitis (croup)?

Answer 59

Parainfluenza virus types 1 and 3.

Question 60

What are the hallmark symptoms of croup?

Answer 60

Barking cough, inspiratory stridor, and respiratory distress.

Question 61

How does croup typically differ from acute epiglottitis?

Answer 61

Croup has a more insidious onset and is less likely to present with systemic toxicity.

Question 62

What is the first-line treatment for mild croup?

Answer 62

Supportive care, such as fluids, upright positioning, and fever management.

Question 63

What medication is commonly used to improve symptoms in moderate to severe croup?

Answer 63

Glucocorticoids (e.g., dexamethasone).

Question 64

What hearing test is typically used for newborn screening?

Answer 64

Otoacoustic emission (OAE) test.

Question 65

What is the Moro reflex used to assess in infants under 6 months?

Answer 65

Response to loud sounds (more than 80 dB) during a behavioral hearing test.

Question 66

What is the auditory brainstem response (ABR) test used for?

Answer 66

To determine the integrity of the auditory pathway up to the brainstem.