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HEENT > Ear Diseases > Flashcards

Ear Diseases Flashcards

1
Q

dry, scaley, painless plaque due to sun damage

A

Actinic Keratosis (AK)

Aka solaris keratosis

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2
Q

Actinic Keratosis -> cancer?

A

10-20% will convert to squamous cell carcinoma in 10-20 years

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3
Q

Trmnts for Actinic Keratosis?

A
  • Cryotherapy
  • spf
  • fluoruracil (5-FU) - chemo cream
  • Imiquimod (Aldara) - warts
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4
Q

fully covered cyst, non-tender, well defined, mobile, slow growing

A

Epidermal Inclusion Cyst (EIC)

Aka Sebaceous cysts

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5
Q

small, symmetrical, fully brown mole since childhood

A

Melanocytic Nevus

local proliferation of melanocytes

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6
Q

treatment

Epidural Inclusion Cyst

A
  • excise if bothersome
  • ABX if infx

looks like crisco

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7
Q

most common malignant tumor of the skin

A

Basal Cell Carcinoma (BCC)

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8
Q

What is it and trmnt?

Painless ulcer/nodule, pearly borders, in the sun a lot

A

Basal Cell Carcinoma

trmnt: Sx excision and 5-fluoruracil (5-Fu) cream

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9
Q

if basal cell carcinoma is left untreated, it can begin to look …

A

rat bitten ulceration

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10
Q

what is it and trmnt?

hard, non-tender, red, nodule or plaque

A

Squamous Cell Carcinoma

trmnt: sx excision, cryotherapy, fluoruracil (5-fu)

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11
Q

sort from best to worst prognosis:
* melaoma
* basal cell carcinoma
* squamous cell carcinoma

A

basal, squamous, melanoma

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12
Q

what and trmnt?

pt is a wrestler with painful big bruise

A

Auricular Hematoma

* I&D
* Pressurre dressing, splint
* ABX (staph)

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13
Q

Auricular Hematoma left untreatred -> ______ deformity

A

cauliflower

48-72 hrs -> aseptic or septic necrosis

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14
Q

what and trmnt?

inflammation only at the pinna (spares the lobe)

2ndary to cellulitis, frostbite, trauma

A

Perichondritis

corticosteroids + ENT referral

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15
Q

relapsing polychondritis is a structural issue caused by ___

A

autoimmune issue

more common in adults

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16
Q

what? trmnt?

honey crusted veisculopustular skin infx commonly seen with thick yellow crusty lesions

A

Impetigo

Bac: staph or strep
Bactroban, Cephalexin (Keflex), etc

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17
Q

what, bac, trmnt?

deep skin infx, red, warm, swollen

A

Cellulitis

Bac: Staph, Strep, H. Influenzae, etc
Rx: ABX

mark borders to track progress

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18
Q

what, trmnt?

pt began to have burning pain in one ear, headache, malaise and fever. 1 week later, pt has vesciles and facial paralysis

hx of chicken pox

A

Herpes Zoster Oticus

trmnt: acyclovir or Valacylovir (antivirals) and Corticosteroids if CN7 or 8 affected

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19
Q

Herpes Zoster Oticus puts you at risk for what?

A

Ramsey-Hunt Syndrome

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20
Q

buy otc ____ up to 4 days to soften cerumen impaction

A

Debrox

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21
Q

rule out a ____ prior to irrigating ear canal

A

TM perforation

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22
Q

Mix warm water + _____ for ear wax rmvl

A

Warm water + H2O2 Hydrogen Peroxide

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23
Q

_____ can kill insects in ears

A

mineral oil, lidocaine, alcohol

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24
Q

use anti-inflammatory ____ drops if ear canal or TM is traumatized

A

cortisporin otic drops

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25
Q

swimmer’s ear = ____

A

Acute Otitis Externa (AOE)

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26
Q

most common cause of otitis externa

A

Psuedomonas aeruginosa

P. aeruginosa (38%)
S. epidermidis (9%)
S. aureus (8%)
Strep pyogenes (6%)

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27
Q

treatment for Otitis Externa

A
  • Ofloxacin/Ciprofloxacin (fluoroquinolones)
  • Ciprodex/Cipro Hydrocortisone (ABX/steroid combo)
  • Cortisporin Otic (neomycin/Polymyxin-B/HC)
  • Domeboro’s sol OTC
  • Cotton ear wick to deliver meds and debride
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28
Q

prevent otitis externa by making alcohol drops after swimming

A

1/3 vinegar + 2/3 rubbing alcohol

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29
Q

complications of otitis externa

A

cellulitis, myringitis, osteomyeltitis of the skull base

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30
Q

workup

order ___ for malignant otitis externa

A

CT/MRI
Ear canal biopsy (to rule out malig tumor)

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31
Q

management

malignant otitis externa

A
  • Antipseudomonal IV ABX for 6-12 wks
  • Oral Cipro
  • Gallium scan (FU)

p. aeruginosa

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32
Q

management

malignant otitis externa

A
  • Antipseudomonal IV ABX for 6-12 wks
  • Oral Cipro
  • Gallium scan (FU)
33
Q

Cellulitis trmnt

A

Ciprofloxacin oral

34
Q

what and trmnt

itchy ears

A

Pruritis
trmnt: mineral oil, clip nails, gloves, topical corticosteroids, oral antihistamines

35
Q

ABX drops _____ can cause contact dermatitis OR ototoxicity

A

Cortisporin (neomycin/polymyxin)

36
Q

flaking skin of ear canal =

A

seborrheic dermatitis

37
Q

bony overgrowth in external ear canal =

A

exostosis/Osteomas

38
Q

if otitis externa or otorrhea doesn’t resolve w/trmnt, suspect _____

A

Squamous cell carcinoma & get biopsy!

39
Q

absence or abnorm narrowing of an oprning or passage in the body

40
Q

what congenital anomaly

opening leading from ear canal or middle ear to pt’s neck or anywhere near ear

A

First Branchial Cleft Anomalies

prone to infx

41
Q

eustachian tube drains into the ____

A

nasopharynx

42
Q

kids under 7 have more sinus related ear infectios due to …

A

their eustachian tube being more flat/horizontal. easier for infections to travel.

43
Q

what

eustachian tube does not open with yawning or swallowing, retracted TM with decreased mobility with valsalva, tympanogram is flat or retracted

A

Eustachian tube sydfunction (ETD)

44
Q

trmnts

Eustachian Tube Dysfunction

A
  • oral decongestants (sudafed)
  • intranasal topical decongestants (afrin up to 4 days bc it constricts blood vessels
  • nasal corticosteroids (flonase)
  • valsalva every day
45
Q

eustachian tube dysfunction creates a ____ pressure

A

negative pressure vacuum

46
Q

what, trmnt?

Bubbles, decreased hearing, plugged feeling, follows URI

A

Serous Otitis Media (SOM)

aka Otitis media with effusion (OME)

trmnt: decongestats (sudafed), corticosteroids (flonase)

47
Q

concern for what?

adult has had unil serous otitis media for a very long time

48
Q

trmnt?

  • TM and middle ear structural damage
  • child has Otitis Media Effusion for 4 months with hearing loss
  • child has speech and learning probs
A

Refer for Tympanostomy Tubes

breaks vacuum (-) pressure to release fluid

49
Q

trmnts

Barotrauma

A
  • elevate head at night
  • meclizine (antivert)
  • steroids (prednisone)
  • avoid cough, sneeze
  • sx repair of fistula (sensorineural hearing loss)
  • myringotomy (conductive hearing loss)
50
Q

risk factors for acute otitis media

A
  • environmental: pollen, mold, tobacco, smoke
  • URI
51
Q

workup for ___ is required for any neonate <1 month with acute otitis media

52
Q

most sensitive finding or acute otitis media

A

bulging red TM

53
Q

viral or bac?

acute otitis media

A

most start viral (48%)
- s. pneumonia (50%)
- H. influenza (20-30%)
- M. catarrhalis (1-5%)

54
Q

trmnt?

AOM

55
Q

abnorm?

A

A. Flat, abnorm glare
B. Otitis media
C. Normal

56
Q

inflammation of TM + Acute otitis media =

A

Bullous Myringitis

Mycoplasma or H. influenza G(-)
same presentation and management as AOM

57
Q

middle ear infx, fever, doughy feel, red, hot, malaise, pain

most frequent serous complication of middle ear infection

A

Mastoiditis

58
Q

Mastoiditis trmnt

A
  • CT
  • Hopsital
  • IV ABX
  • Mastoidectomy
59
Q

Otitis Media + purulent aural discharge (TM Perf) =

A

Chronic Otitis Media (COM)

60
Q

Bac of Chronic Otitis Media vs Acute Otitis Media

A

COM: P. Aeruginosa, Proteus species, S. Aureus, mixed anaerobic infx
AOM: S. Pneumonia, H. Influenza, M. Catarrhalis

61
Q

Trmnt: Chronic recurrent Otitis Media

A
  • Perforation -> ABX drops (Ofloxacin or Ciprodex)
  • Suppressive Therapies X 6 months (Trimethoprim/Sulfamethoxazole OR Amoxicillin)
  • TM Tubes
62
Q

Indications for tympanostomy tubes

63
Q

Prolonged eustachian tube dysfunction causes TM to retract upwards. Keratin debris accumulates in the “attic”

A

Cholesteatoma

64
Q

Order ___ for Cholesteatoma

65
Q

Cholesteatoma complications

A
  • ossicular chain bone erosion
  • sensorineural hearing loss
  • facial nerve injury
  • dizziness
66
Q

when infx from otitis media and mastoiditis spreads to the arrowed regions

A

Petrous Apicitis

67
Q

pt has otitis media and presents with otorrhea, diplopia, and facial pain

otitis media + ____ syndrome = _____

A

otitis media + Gradenigo’s Syndrome = Petrous Apicitis

68
Q

Petrous Apicitis

imaging order and plan

A
  • CT/MRI
  • prolonged ABX therapy (deep infx)
  • sx drainage
69
Q

Unilateral hearing loss, past Hx of ipsilateral TM perf, tinnitus w/ persistent purulent otorrhea

A

Cholesteatoma caused by prolonged eustachian tube dysfunction.

70
Q

Trmnt for Acute Otitis Media or Chronic Otitis Media + Facial Paralysis?

A

AOM: Myringotomy for drainage; IV ABX
COM: treat underlying issue (chronic pressure on CN7 by cholesteatoma)

71
Q

Most common intracranial complication of ear infection

A

CNS Infection - Otogenic meningitis

72
Q

Pt has an ear infection. While laying on their back, extending their knees from a 90 degree position is painful. Flexing their neck causes pain and their hips and knees to flex too. What complication? Dx and trmnt?

A

CNS Infection - Otogenic Meningitis
Dx. Lumbar puncture
Inpatient ABX

73
Q

Ear infection that spreads to the brain is most likely to affect which lobes?

A

Temporal or cerebellar

74
Q

No infection, conductive hearing loss, vertigo, low pitched tinnitus

A

Otosclerosis (stapes footplate (oval window) is too bony)

75
Q

Chronic Otitis Media Complication

A
  • cholesteatoma
  • petrous apicitis
  • otogenic skull base osteomyelitis
  • facial paralysis
  • sigmoid sinus thrombosis
  • CNS infx
76
Q

What drops can you use for TM perforation + bacterial infection

A

Floxin Otic Drops
(Absolutely no neomycin toxic drops)

77
Q

Red pulsatile middle ear mass, pulsatile tinnitus, hearing loss

A

Glomus Tympanum (benign)

78
Q

Order ___ for pulsatile tinnitus

A

MR Angiography

79
Q

Acute Otitis Media trmnt in children

A

Amoxicillin. Azithromycin if PCN Allx

HEENT (9 decks)

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