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CSI > ear/nose > Flashcards

ear/nose Flashcards

1
Q

conductive hearing loss

A

dysfunction of middle or external ear

  • obstruction, effusion, stiffness or ossicle disruption
  • most common: cerumen impaction or eustachian tube dysfunction (temp/reversible)
  • if persistent: chronic inf., trauma, otosclerosis (stiffening of membrane)
  • can be corrected w. hearing aids/surgery
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2
Q

sensory hearing loss

A

cochlear pathology: loss of hair cells from organ of Corti
(often combo w/ neural)
-may be due to excessive noise/trauma
-high freq. lost w/ age
-not surgically correctable but preventable

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3
Q

neural hearing loss

A

lesion of CN VIII, auditory nuclei, ascending tracts or cortex
-acoustic neuroma, MS, neuropathy

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4
Q

Weber test

A

-sound will be louder in affected ear if bone
conduction loss, opposite with sensory neural
(whisper test first)

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5
Q

Rinne test

A

air should exceed bone >2:1

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6
Q

who gets referred for testing

A
  • everyone w/ hearing loss unless you have an obvious reversible cause
  • i.e. mastoiditis
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7
Q

traumatic auricular hematoma (TAH) if untreated can lead to

A 
cauliflower ear (boxers)
(cartilage necrosis)
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8
Q

chondritis/perichondritis vs cellulitis

A

earlobe spared in chondritis (not cartilage)

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9
Q

main cause of cerumen impaction

how to tx?

A

cause: Qtips in canal
- use curettes to clean out
- soften earwax w/ warm water
- Debrox: peroxide drops, softens earwax

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10
Q

if insect in ear

A

drown in lidocaine, flush out

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11
Q

what else in ears

A

toys, hairtip, Qtip tips

irrigate and/or use alligator forceps or refer to ENT

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12
Q

external otitis assoc. w/

A

excess moisture, tropics, swimmers, DM

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13
Q

pathogens in otitis externa

A

G- rods, fungi, pseudomonas

can get Cs if purulent

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14
Q

tx of otitis externa

A

acetic acid/etOH drops (dry out, kill fungus)

FQ drops +/- oral abx (if severe/malignant)

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15
Q

if swollen shut w/ otitis externa

A

use ear wick: into canal thru inflammation: put numbing meds + abx on strip–>expands–>relief (also use oral abx to avoid noncompliance)

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16
Q

complications with otitis externa

A

mastoiditis: fluid in/obstruction of air cells
meningitis, facial nerve palsy, encephalopathy, sinus cavernous thrombosis, tymp. mem. rupture
squamous cell carcinoma (SCC): most common neoplasm (typ. local, not usually metastasis)

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17
Q

eustachian tube disorders

A

present w/ fullness, hearing changes, popping/pain w. pressure changes, inc. risk for serous otitis

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18
Q

eustachian tubes with age

A

babies/kids: more horizontal

adults: vertical, stiffened (less dysfunction)

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19
Q

how to tx serous otitis

A 
nasal spray (steroids): dec. congestion/inflamm of meatuses for drainage (clears eustachian tubes)
-oral steroids if that does not work
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20
Q

if on plane with congestion

A

valsalva, blowing out
-nasal sprays first, then sedated (dry out sinuses) and phenylephrine (nasal spray)–>can be addictive! rebound congestion when wears off

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21
Q

divers can get

A

barotrauma

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22
Q

acute otitis media tx

A

amoxicillin, augmentin

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23
Q

acute OM pathogens

A

strep. pneumo, strep, pyogenus (only in Current), H. influenza, 10% staph aureus

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24
Q

chronic OM pathogens

A

pseudomonas, proteus, staph

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25
Q

OM observ. on PE

A

*dec. mobility of TM, erythematous (insuflate) +/- fever

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26
Q

OM tx

A

nasal spray for symps. amoxicillin–>w/ clauvulinic acid (augmentin) if not improving or fever
if allergic: erythromycin + sulfonamide
or cephalosporins if no type 1 hypersens

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27
Q

chronic otitis media

A

sim. abx tx, usually longer

28
Q

OM complications

A

cholesteatoma, mastoiditis, petrous apicitis, paralysis, sinus thrombosis, CNS spread, chronic perf., scarring of TM, meningitis (S. pneumo)

29
Q

severe ear pain with normal presentation

A

look for signs of inf, treat pain, neurogenic

-shingles: tingling comes before rash, Ramsey-Hunt

30
Q

referred ear pain

A

neurogenic pain (trigeminal, facial gloss pharyngeal, vagal and cervical innervation of ear structures), TMJ

31
Q

otoxicity

A 
ASA: typ. rev and dose related
aminoglycosides
loop diuretics (Furosamide) Ca meds
32
Q

sudden hearing loss considered idiopathic may respond to..

A

corticosteroids, refer to audiology

33
Q

sens. hearing loss beginning in adulthood often

A

hereditary, assoc. w/ connexin-26 mutation

34
Q

how to tx tinnitis

A

avoid offending substance

-tricyclic antidepressants (nortriptaline)

35
Q

peripheral vertigo

A

sudden +/- tinnitis, hearing loss
horizontal fatiguable nystagmus
dizziness may stop, prolonged imbalance

36
Q

central vertigo

A

gradual +/- audio symptoms
vertical unfatiguable nystagumus
smtms rotary nystagmus (PCP/ketamine)
motion imbalance

37
Q

causes of peripheral vertigo

A 
vestibular neuritis/labyrinthitis
meniere disease
benign positional vertigo
etOH intox
inner ear barotrauma
semicircular canal dehiscence
38
Q

causes of central nystagmus

A 
seizure 
MS
Wernicke encephalopathy
Chiari malformation
cerebellar ataxia syndromes
39
Q

mixed central and peripheral causes of vertigo

A 
migraine, stroke, vasc. insuff., PICA, AICA stroke, vert. art. insuff, vasculitides, cogan syndrom, susac syndrome
granulomatosis w. polyantiitis (wegener)
Behcet disease
cerebellopontine angle tumors
vestibular schwannoma
meningioma 
infections: lyme disease, syphilis
vascular compression
hyperviscosity syndromes
Waldenstrom macroglobulinemia
endocrinopathies
hypothyroidism
pendred syndrome
40
Q

ddx vertigo + audio symps

A

secs: perilymphatic fistula
hrs: endolymphatic hydrops (meniere, syphilis)
days: labyrinthitis, labyrinthine concussion, AI inner ear dis
mos: acoustic neuroma, ototoxicity

41
Q

ddx vertigo - audio symps

A

secs: positioning vertigo (cupulolithiasis), vertebrobasilar insuff., migraine-assoc.
hrs: migraine-assoc.
days: vestibular neuronitis, migraine-assoc.
mos: MS, cerebellar degen.

42
Q

viral rhinosinusitis

A

the common cold
(rhinovirus, coronovirus, adenovirus)
typ. self-limited

43
Q

viral rhino sinusitis can lead to bacterial inf.

A

if >7-10 days

44
Q

other complications from viral rhinosinusitis

A 
otitis media (inflamm. of sinuses), 
bronchitis (inflames epithelial cells) also causes laryngospasm-->asthma
45
Q

viral rhinosinusitis presentation

A

runny nose +/- fever, cough (wet/dry)
clear vs. purulent mucus
“green boogers” day 10 OR chronic–>tx for bac inf
cobblestoning, hyponosmia, malsaise, sore throat, HA

46
Q

how to tx the common cold

A

oral hydration, rest, tylenol (phenylephrine/dayquil), decongestants, sudafed
localized steroid, afrin, nasal saline spray, breaks up mucus and dilutes pathogens

47
Q

bacterial rhinosinusitis

A

not as common as viral

imp. mucociliary clearance, obstruction of osteomeatal complexes (secondary inf.)

48
Q

bac rhinosin pathogens

A

strep pneumo/cocci, staph, H. flu, moraxella

49
Q

clinical criteria for BF

A

purulent discharge, mucus

length/severity to ddx from viral

50
Q

types of BR

A

maxillary (dental pain), ethmoiditis, sphenoid sinusitis (behind eye pressure), frontal sinusitis, hospital-assoc. sinusitis (IC, tubes in body, nosocomial pathogen exposure, lying down, surgery, nasal packing)

51
Q

?? if low grade fever consider

A

thromboembolism

52
Q

how to see sinuses

A

CT, MRI

53
Q

how to tx BR: first-line

A

amoxicilin, trimethoprim-sulfamethoxazole, doxycycline, amoxicillin-clavulanate

54
Q

how to tx BR: first-line after recent abx use

A

levofloxacin

amoxicillin-clavulanate

55
Q

how to tx BR: second-line

A

amoxicillin-clavulanate, moxifloxacin

56
Q

potential complications of BR

A

orbital/periorbital cellulitis, empyenas on brain, meningitis, mastoiditis, osteomyelitis–>sprd to frontal bone–>Pott’s puffy tumor (debridement/surgery)

57
Q

who comes to the hospital w/ BR

A

frontal osteomyelitis
orbital cellulitis
immunecomps, chemo pts., already done 1st/2nd line tx, need IV
facial cellulitis

58
Q

allergic rhinitis

A
  • seasonality: pollens, spores, some year round: dust
  • s/s sim to viral rhinitis
  • ddx from vasomotor rhinitis: allergy tx, vasomotor improves w/ apotropium spray
59
Q

allergic rhinitis tx

A
  • intranasal corticosteroid: can take 2-4 wks, probe: not supposed to sniff up, may cause anosmia, nosebleeds
  • antihistamines: non-sed. vs sedating (Claritin, Zertec, Allegra, Alvert), work faster than nasal spray, complications: over dry, sedation, dev. resistance, need to switch class
60
Q

adjunct tx for allergic rhinitis

A
  • antileukotriene meds (montelukast)
  • mast cell stabilizers (cromolyn sodium, sodium nedocroil)
  • anticholinergic nasal sprays (ipratropium bromide) -for vasomotor rhinitis
61
Q

olfactory dysfunction

A

send to neurologist?
caused by obstruction of nasal cavity by polyps, tumors, septal deformity
-dec. taste, may cause anorexia
transient w/ cold s/s nasal allergies
idiopathic, trauma, worry about safety concern: CO/gas/fire detectors

62
Q

epistaxis

A

typ. anterior and unilateral

* Kiesselbach’s plexus

63
Q

causes of epistaxis

A

nasal trauma, rhinitis, dry mucosa, deviated septum, HTN, atherosclerosis, hereditary hemorrhagic telangiectasia (osler-weber-rendu syndrome)
cocaine/etOH use

64
Q

epistaxis: det. causes and area

A

trauma
lean back? no will swallow blood, use direct pressure
blow out to det. where, oozing or bleeding?-phenylephrine spray to constrict/cauterize vessels, packing, cocaine (vasoconstr)

65
Q

tx options for epistaxsis

A 
direct pressure, topical nasal decong.
topical cocaine (4%)
patch (surgicel)
packing
thrombin: aerosol in nos, forms clot
embolization

CSI (75 decks)

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