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Ear, Nose, and Throat > Ear, Nose and Throat > Flashcards

Ear, Nose and Throat Flashcards

1
Q

What is Conductive Hearing Loss?

A

the dysfunction of the External air Middle Ear

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2
Q

What is the etiology of conductive hearing loss?

A

1 Obstruction : cerumen, otitis externa
2 Middle rare effusion, scarring
3 Otosclerosis: abnl bone formation

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3
Q

What is the Tx for conductive hearing loss?

A

it is generally correctable with medical or surgical therapy

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4
Q

What is Neural Hearing Loss?

A
  • lesions to the 8th CN or central pathway

- it is the least common type of hearing loss

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5
Q

What is the etiology of neural hearing loss?

A
  • Acoustic nuron : F > M, unilateral
  • Multiple Sclerosis
  • Cerebrovasular disease
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6
Q

Describe the typical history with Sensorineural hearing loss?

A
  • it is the typical progressive, predominantly high-frequency loss with advanced age
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7
Q

Where is the tuning fork placed with the Weber test?

A

placed on the forehead

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8
Q

What are the Weber test findings in unilateral conductive losses?

A

the sound appears loader in the affected ear (poorer hearing)

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9
Q

What are the Weber test findings in unilateral sensorineural losses?

A

sound radiates louder to the unaffected ear (normal hearing)

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10
Q

Where is the tuning fork placed with the Renne Test?

A

it is placed on the mastoid bone and then front of the ear canal

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11
Q

What are the Rinne findings with conductive hearing loss?

A

in bone conduction losses, bone conduction exceeds air conduction

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12
Q

What are the Rinne test findings with Senosrineural hearing loss?

A

both air conduction and bone conduction are equally depreciated

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13
Q

What are the S/Sx of External Otitis? (swimmers ear)

A
  • Otalgia
  • pruritis
  • purulent discharge
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14
Q

What is the etiology of External Otitis?

A

-Pseudomonas (gram neg rods) or fungi

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15
Q

What are the risk factors for External Otitis?

A
  • water exposure

- mechanical trauma

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16
Q

What is the Tx for external otitis?

A
  • antibiotic ear drops, +/- ear wick

- (neoomycin sulfate, polymyxin B sulfate)

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17
Q

What causes Viral Otitis Externa?

A

usually caused by Varicella Zoster

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18
Q

What is Ransey-Hunt Syndrome?

A

otitis extern with CN 7 palsy

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19
Q

What are the S/Sx of viral otitis external?

A
  • severe ear pain

- visicles in the external auditory canal or around the ear

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20
Q

What is the Tx for viral otitis externs?

A
  • antivirals
    • acyclovir, valcyclovir, famcyclovir
    • +/- steroids
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21
Q

What is Malignant External Otitis?

A

persistent external otitis causing a necrotizing and osteomylitis of the skull base

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22
Q

What are the risk factors for Malignant External Otitis?

A

diabetics and immunocompromised patients

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23
Q

What is the Tx for Malignant External Otitis?

A
  • prolonged antipseudomonal antibiotics (usually IV)

- +/- surgical debridement

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24
Q

What is Acute Otitis Media?

A

it is a bacterial infection of the mucosally lined air contained spaces of the temporal bone

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25
Q

What is the etiology of acute otitis media?

A

-Poor drainage from the eusachian tubes

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26
Q

What are bacteria etiology of acute otitis media?

A
  • streptococcus pneumoniae or pyogenes
  • haemophilus influezae
  • Morazella catarrhalis
  • staphylococcus
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27
Q

What are the S/Sx of acute otitis media?

A
  • otalgia
  • aural pressure
  • decreasing pressure
  • +/- fever
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28
Q

If bullae (blisters) are seen with Acute Oitis Medial, what is the organism causing this?

A

-Mycoplasma pneumoniae

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29
Q

What are the physical exam findings for acute otitis media?

A
  • immobile eardrum

- red, bulging tympanic membrane

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30
Q

What are the Tx for acute otitis media?

A 
Antibiotics
     amoxicillin or augmentin
     cephalosporins
     erythromycin + sulfonamide
Tympanic membrane perforation

tympanic membrane rupture : relieves pain immed.

Tubes (surgery)

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31
Q

What are the organisms that cause Chronic Otitis Media?

A
  • pseudomonas aeruginosa
  • proteus species
  • staphylococcus aureus
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32
Q

What is the hallmark characteristic of chronic otitis media?

A

purulant aural discharge

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33
Q

What is the Tx for chronic otitis media?

A

topical antibiotic ear drops

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34
Q

What is Serous Otitis Media?

A

inability to aerate the middle ear

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35
Q

What characteristics of serous otitis media?

A

pain and fever are absent

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36
Q

What are the physical exam findings of serous otitis media?

A
  • fluid is present

- Tm is retracted with bony landmarks preserved

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37
Q

What is the Tx for serous otitis media?

A

Surgery, tubes are recommended for chronic cases

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38
Q

What is a Cholesteatoma?

A

a growth of skin cells behind the eardrum that cause damage to the tympanic membrane itself, the bones of the ear, and sometimes to the nerve

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39
Q

What causes a Cholesteatoma?

A
  • is due to a prolonged auditory tube dysfunction, with resultant chronic negative middle ear pressure that draws inward the tympanic membrane
  • this area becomes filled with desquamated keratin and becomes chronically infected
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40
Q

What may eventually occur with a cholesteatoma?

A

may erode bone

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41
Q

What are the complications of Otitis Media?

A
  • masoiditis
  • osteomyelitis
  • facial paralysis
  • central nervous system infection
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42
Q

What are the S/Sx of masoiditis?

A

post auricular pain and erythema with spiking fever

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43
Q

What is the Tx for mastoiditis?

A

IV antibiotics or surgery if no improvement

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44
Q

What is the organism responsible for Osteomyelitis in otitis media?

A

pseudomonas

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45
Q

What is the Tx for Facial Paralysis seen in Otitis media?

A

IV antibiotics and myringotomy

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46
Q

What organisms are responsible for central nervous infection of otitis media?

A

Meningitis : H. influenzae and Strep pneumo

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47
Q

What is Vertigo?

A

a feel in that you or your environment is moving or spinning

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48
Q

Vertigo is a cardinal symptom of abnormality of what system?

A

the vestibular system

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49
Q

Describe vertigo.

A

an illusion of movement (usually rotational)

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50
Q

Where is the problem of vertigo located?

A

anywhere from the vestibular end organs to the temporal bone

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51
Q

Which lesions cause the most systemic upset?

A

the peripheral lesions

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52
Q

What are the vertigo systemic symptoms that the peripheral lesions cause?

A
  • pallor
  • sweating
  • nausea
  • vomiting

also:

-sudden onset of hearing loss and tinnitus

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53
Q

How long does benign positional vertigo last?

A

30 min to 12 hours

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54
Q

How long does vestibular neuritis vertigo last?

A

days to weeks

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55
Q

How long does labryinthitis last?

A

days to weeks

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56
Q

How long does acoustic neuroma vertigo last?

A

months

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57
Q

How long does Ototoxicity vertigo last?

A

months

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58
Q

How long does Multiple Sclerosis vertigo last?

A

months

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59
Q

How long does Psychogenic vertigo last?

A

several years

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60
Q

What is the classic syndrome of Meniere’s disease?

A
  • episodic vertigo
  • hearing loss
  • tinnitis and sensation of aural pressure
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61
Q

What is the etiology of Meniere’s Disease?

A
  • distention of the membranous labrinyh (endolymph pressure)
  • syphillis
  • head trauma
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62
Q

What are the S/Sx of Meniere’s disease?

A
  • symptoms wax and wane +/- N/V

- low frequency fluctuation hearing loss

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63
Q

What is the Tx for Meniere’s Disease?

A

-Low-salt diet
-Diuretic
+/- surgery

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64
Q

What is labyrinthitis?

A
  • inflammation

- irritation and swelling of the inner ear (the labyrinth)

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65
Q

Describe the clinical picture of Labyrinthitis?

A

-acute onset of continuous, usually severe vertigo lasting several days to a week, accompanied by HEARING LOSS AND TINNITIS

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66
Q

What may bring on the transient vertigo of Labyrinthitis?

A

-unknown but often follows an upper respiratory infection

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67
Q

What is the Tx for Labyrinthitis?

A
  • meclizine
  • promethazine
  • dimenhydrinate
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68
Q

What is Vestibular Neuronitis?

A
  • a paroxysmal, usually single attack of vertigo occurs without accompanying impairment of auditory function
  • no loss of hearing
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69
Q

What is the etiology Vestibular Neuronitits?

A

probably a viral infection

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70
Q

What are the S/Sx of Vestbular Neuronitis?

A
  • vertigo
  • N/V
  • lasts days to weeks
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71
Q

What is the Tx for Vestibular Neuronitis?

A

Tx the symptoms

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72
Q

Describe Benign Paroxysmal Positional Vertigo (BPPV)?

A
  • vertigo symptoms that occur a few seconds after head movements
  • this vertigo lasts 10-60 seconds
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73
Q

What is the etiology of Benign Paroxysmal Positional Vertigo (BPPV)?

A

-free floating debris within a semicircular canal

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74
Q

What are the symptoms of Benign Paroxysmal Postional Vertigo?

A

-vertigo with torsional nystagmus

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75
Q

How is BPPV diagnosed?

A

Epely maneuver

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76
Q

How is BPPV treated?

A

-Repositional techniques
Hallpike maneuver
Epley maneuver
Nylen-Barany maneuver

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77
Q

What are the Tx for Vertigo?

A
  • antihistamines
  • Meclizine (antivert)
  • Promethazine
  • Scopolamine patch
  • Phenothiazine (compazine)
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78
Q

What are the side effects of a Scopolamine patch?

A
  • dry mouth
  • blurred vision
  • urinary obstruction
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79
Q

What are the 3 types of Nystagmus?

A
  • Downbeat Vertical Nystagmus
  • Peripheral Nystagmus
  • Central Nystagmus
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80
Q

Is Downbeat Vertical Nystagmus pathologic?

A

yes, it is pathologic

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81
Q

Describe the eye movement with Peripheral Nystagmus?

A

move slowly in one direction and then rapidly to midline

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82
Q

What does Multidirectional or vertical nystagmus indicate?

A

it indicates a brainstem injury

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83
Q

What does nystagmus without vertigo indicate?

A

it indicates a central lesion

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84
Q

What are the characteristics of Peripheral Nystagmus?

A
  • sudden onset
  • fatigue symptoms
  • horizontal movement with rotary component
  • vertigo is common
  • enhanced by loss of visual fixation
  • usually temporary
  • Also: N/V, tinnitis, and decreased hearing
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85
Q

What are the characteristics of Central Nystagmus?

A
  • slower onset
  • no fatique
  • Vertical > Horizontal nystagmus
  • may not have vertigo
  • no change with loss of visual fixation
  • may be permanent
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86
Q

What is Barotrauma?

A

the inability to equalize barometric stress on the middle ear, resulting in pain

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87
Q

What is the etiology of Barotrauma?

A

auditory tube disfunction

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88
Q

What are the S/Sx of Barotrauma?

A

most likely to occur during an airplane descent, rapid altitude descent, or underwater diving

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89
Q

What is the Tx for barotrauma?

A
  • frequent swallowing or yawning to auto inflate the tube

- +/-decongestants

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90
Q

What are the complications for barotrauma?

A

middle ear infection

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91
Q

What is another term for Acoustic Neuroma?

A

Vestiblular Schwannoma

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92
Q

What is an Acoustic Neuroma or Vestibular Schwannoma?

A

tumor of the Eighth Cranial Nerve

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93
Q

What type of hearing loss does and Acoustic Neuroma cause?

A

sensorineural hearing loss

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94
Q

Does an Acoustic Neuroma cause dizziness?

A

it takes the form of continuous dysequilibrium than episodic vertigo

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95
Q

How does an acoustic neuroma Dx?

A

MRI

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96
Q

What is the Tx for an acoustic neuroma/Vestibular Schwannoma?

A

surgery

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97
Q

What are the S/Sx of a Viral Rhinitis?

A
  • watery rhinorrhea, sneezing
  • Nasal congestion, headache
  • Scratchy throat, general malaise
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98
Q

What are the etiology of Viral Rhinitis?

A
  • rhinoviruses
  • adenoviruses
  • RSV
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99
Q

What are the PE findings for a Viral Rhinitis?

A
  • reddened, edematous mucosa

- watery discharge

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100
Q

What are the Tx for Viral Rhinitis?

A
  • decongestants
  • nasal sprays
  • hydration
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101
Q

What is a another name for Allergic Rhinitis?

A

Hey fever

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102
Q

What is the etiology of allergic rhinitis?

A

IgE hypersensitivity

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103
Q

Allergic Rhinitis is often associated with what other medical conditions?

A
  • asthma
  • eczema
  • atopic dermatitis
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104
Q

What are the etiology for allergic rhinitis?

A
  • pollens
  • grasses
  • ragweed
  • dust
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105
Q

What are the S/Sx of allergic rhinitis?

A
  • eye irritation
  • erythema
  • excessive tearing
  • rhinorrhea
  • sneezing
  • dry cough
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106
Q

What are the PE findings for allergic rhinitis?

A

-pale and boggy nasal mucosa

+/- polyps

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107
Q

What is the Tx for allergic rhinitis?

A

-Nasal corticosteroid sprays

  • oral decongestants (pseudoephedrine)
  • antihistamines,
  • mast cell stabilizers (Nasacrom)
108
Q

What is Vasomotor Rhinitis?

A

is a syndrome of nasal blockage and rhinorrhea without evidence of immunologic or infectious nasa disease

it involvers increased parasympathetic activity of the nasal mucosa

109
Q

What are the factors that exacerbate Vasomotor Rhinitis symptoms?

A
  • environmental temperature
  • humidity
  • stress
  • smoke
  • odors
  • weather
  • exercise
  • alcohol
110
Q

What is the Tx for vasomotor rhinitis?

A

-avoid the irritant

+/- atrovent nasal spray

111
Q

What is Rhinitis Medicatmentosa?

A

rhinitis caused by overzealous use of decongestant drops or sprays

112
Q

How does overuse of decongestant drops or sprays cause rhinitis?

A

cause a rebound congestion

113
Q

What are the S/Sx of Rhinitis Medicamentosa?

A

bogginess of the nasal mucosa associated with complaints of stuffiness and rhinorrhea

114
Q

What is the Tx for Rhinitis Medicamentosa?

A

discontinue the irritant (the spray or drops)

115
Q

What are the PE findings for a Viral Rhinitis?

A
  • reddened, edematous mucosa

- watery discharge

116
Q

What are the Tx for Viral Rhinitis?

A
  • decongetants
  • nasal sprays
  • hydration
117
Q

What is a another name for Allergic Rhinitis?

A

Hey fever

118
Q

What is the etiology of allergic rhinitis?

A

IgE hypersensitivity

119
Q

Allergic Rhinitis is often associated with what other medical conditions?

A
  • asthma
  • eczema
  • atopic dermatitis
120
Q

What are the etiology for allergic rhinitis?

A
  • pollens
  • grasses
  • ragweed
  • dust
121
Q

What are the S/Sx of allergic rhinitis?

A
  • eye irritation
  • erythema
  • excessive tearing
  • rhinorrhea
  • sneezing
  • dry cough
122
Q

What are the PE findings for allergic rhinitis?

A

-pale and boggy nasal mucosa

+/- polyps

123
Q

What is the Tx for allergic rhinitis?

A

-Nasal corticosteroid sprays

  • oral decongestants (pseudoephedrine)
  • antihistamines,
  • mast cell stabilizers (Nasacrom)
124
Q

What is Vasomotor Rhinitis?

A

is a syndrome of nasal blockage and rhinorrhea without evidence of immunologic or infectious nasa disease

it involvers increased parasympathetic activity of the nasal mucosa

125
Q

What are the factors that exacerbate Vasomotor Rhinitis symptoms?

A
  • environmental temperature
  • humidity
  • stress
  • smoke
  • odors
  • weather
  • exercise
  • alcohol
126
Q

What is the Tx for vasomotor rhinitis?

A

-avoid the irritant

+/- atrovent nasal spray

127
Q

What is Rhinitis Medicatmentosa?

A

rhinitis caused by overzealous use of decongestant drops or sprays

128
Q

How does overuse of decongestant drops or sprays cause rhinitis?

A

cause a rebound congestion

129
Q

What are the S/Sx of Rhinitis Medicamentosa?

A

bogginess of the nasal mucosa associated with complaints of stuffiness and rhinorrhea

130
Q

What is the Tx for Rhinitis Medicamentosa?

A

discontinue the irritant (the spray or drops)

131
Q

What is Epistaxis?

A

nose bleed most commonly due to bleeding from Kiesselbach’s plexus (anterior nasal septum)

132
Q

What is the etiology of epistaxis?

A
  • nasal trauma
  • rhinitus
  • drying
  • alcohol use
  • anticoagulants
133
Q

What is the Tx for Epistaxis?

A
  • direct pressure while sitting and leaning forward
  • vasoconstricting nasal sprays
  • nitrate stick
  • nasal packing
134
Q

What are Nasal Polyps?

A

pale, edematous, mucosally covered masses

135
Q

What other medical conditions are nasal polyps associated with?

A
  • commonly linked with allergic rhinitis

- in children think cystic fibrosis

136
Q

What is the Tx for nasal polyps?

A
  • topical steroids
  • surgery
  • avoid aspirin if the patient has nasal polyps and a history of asthma, aspirin may precipitate bronchospasm
137
Q

What are the pathogens that cause Actue Sinusitis?

A
  • Strep pneumoiae & pyogenes
  • H. influenzae
  • Staph aureus
138
Q

What are the risk factors for an Acute Sinus Infection?

A
  • recent URI
  • smoking
  • foreign body
  • rhinitis
139
Q

What are the signs and symptoms of an Acute Sinus Infection?

A

-facial pain
-pressure over the sinuses
-referred pain to the upper teeth
-purulent nasal drainage with congestion
+/- fever, malaise

140
Q

What are the PE exam findings for an acute sinus infection?

A
  • tenderness to palpation

- opacification with transillumination

141
Q

What tests can confirm a Dx of an acute sinus infection?

A
  • Sinus X-ray (water’s view)

- CT scan

142
Q

What is the Tx for an Acute Sinus Infection?

A
  • oral decongestants : pseudoephedrine
  • nasal decongestant sprays
  • topical heat, hydration, humidified vapor

-Oral Antibiotics : for 10 days
Amoxicilliin / Augmentin
Bactirm
Cephalosporin

143
Q

What are the possible complications of an Acute Sinus infection?

A
  • osteomylelitis
  • orbital cellutitis
  • covernous sinus thrombosis
144
Q

Describe Glossitis.

A

red, smooth-surfaced tongue with loss of filform papliiae

145
Q

What is the etiology of Glossitis?

A 
1 drug reactions
2 autoimmune reactions
3 nutritional deficiencies
     Niacin
     riboflavin
     vitamin E
146
Q

What is Gossodynia?

A

burning and pain of the tongue

147
Q

What is the etiology of Glossodynia?

A
  • diabetes
  • tobacco
  • candidiasis
  • drugs (diuretics)
148
Q

Describe Thrush (Candidiasis)?

A

-creamy-white curd-like patches overlying erythematous mucosa

149
Q

What is the etiology for Thrush?

A

Candida Albicans

150
Q

What are the risk factors for Candidiasis (Thrush)?

A
  • denture wearers
  • dibilitation
  • diabetes
  • anemia
  • chemotherapy
  • antibiotics
  • steroids
151
Q

What are the signs and symptoms of Thrush (Candidiasis)?

A

painful, sore throat

152
Q

What is the lab test to Dx Thrush?

A

wet prep with potassium hydroxide

153
Q

What is the Tx for Thrush?

A

-Fluconazole
“swish and swallow”
-Ketoconazole
“swish and swallow”

154
Q

What is an Apthous Ulcer?

A

AKA : canker sore

155
Q

Describe the Apthous Ulcer appearance?

A

2mm-2 cm painful round ulcerations with yellow-grey fibrinoid centers surrounded by red halos

they are painful and last around 7 days, healing completely in 1-3 weeks

156
Q

What is the Tx for an Aphthous Ulcer/ canker sore?

A
  • symptomatic relief (orabase gel)

- topical prednisone

157
Q

What medication is associated with numerous ulcers?

A

Behchet’s disesae

158
Q

What is another name for oral herpes?

A

AKA : herpetic gingivostomatitis

159
Q

What is the etiology for oral herpes?

A

herpes simplex virus type 1

160
Q

What are the risk factors for Herpetic Gingivostomatitis?

A
  • immunocompromised
  • trauma
  • emotional stress
  • sunlight exposure
161
Q

What are the S/Sx of oral herpes?

A

burning erythematous papules with vesicles that rupture

162
Q

What lab test is used to Dx oral herpes?

A

+ Tzank smear & culture

163
Q

What is the Tx for Oral Herpes?

A

antivirals

164
Q

What is a Leukoplakia lesion?

A
  • a white oral lesion that cannot be removed by simply rubbing the mucosal surface
165
Q

What is a Leukoplakia lesion due to?

A

they are a response to chronic irritation : dentures, smokers, chew tobacco, ETOH, AIDS

166
Q

What percentage of Leukoplakia lesions are precancerous?

A

10% of Leukoplakia are precancerous

167
Q

Describe Erythroplakia?

A
  • 90 % are precancerous

- similar to leukoplakia with a definite erythematous component

168
Q

What is oral cancer

A

Squamous cell carcinoma (90%)

169
Q

What are the RF for oral cancer?

A

-alcohol and tobacco use

170
Q

What is pharyngitis?

A

a sore throat caused by a virus or bacteria

171
Q

What are the etiology for pharyngitis?

A

-GABHS (Group a B-Hemolytic Streptococcal)

-Viruses: coryza, often lack exudate, low grade fever,
+/- lymphadenopathy

  • Neisseria gonarrhoea, mycoplasma, chlamydia, trachomatis
  • Diphtheria (grey tonsillar pseudomembrane)
172
Q

What are the S/Sx of pharyngitis?

A
  • sever throat pain
  • odynophagia
  • lympthadenopathy
173
Q

What are the S/Sx of GABHS?

A
  • most common age 5-12
  • Fever > 38 degrees
  • tender anterior cervical adenopathy
  • lack of cough
  • pharyngotonsillar exudate
174
Q

What are the Lab findings for GABHS?

A

-leukocytosis with left shift

+ rapid strep screen

175
Q

What is the Tx for GABHS?

A

-penicillin (oral) for 10 days or erythromycin

176
Q

What ae the complications for GABHS?

A
  • scarlet fever/rheumatic fever
  • glomerulonephritis
  • rheumatic myocardits
  • local abscess formations
177
Q

What is the etiology for Mononucleosis?

A

-Ebstein-Barr virus (EBV)

178
Q

What are the S/Sx for Mononucleosis?

A
  • malaise
  • sore throat
  • odnophyagia
  • marked lymphadenopathy
  • hepatosplenomegaly
179
Q

What are the physical exam findings for Mononucleosis?

A

-shaggy white-purple exudate

180
Q

What Lab is used to Dx Mononucleosis?

A

+ Herophil agglutination test (Monospot)

-elevated anti-EBV titer

181
Q

What is the Tx for Mononucleosis?

A

-symptomatic

182
Q

What antibiotic should be avoid with mononucleosis?

A

-ampicillin

183
Q

What are the S/Sx for a Peritonsillar Abscess?

A
  • trismus, fever, drooling, muffled voice
  • sever sore throat, odynophagia, dysphagia
  • deviation of the soft palate and “hot potato voice”
184
Q

What is the Tx for a peritonsillar abscess?

A

-aspiration or incision and drainage
-parental antibiotics
+/- tonsillectomy

185
Q

What is Sialadenitis?

A

acute swelling of the parotid or submandibular gland due to ductal obstruction

186
Q

What is the etiology of Sialadenitis?

A

usually bacterial (staph aureus)

187
Q

What are the S/Sx of Sialadenitis?

A
  • increased pain and swelling with meals

- pus may be massaged from the duct

188
Q

What medical conditions are associated with Sialadentitis?

A
  • dehydration

- Sjogren’s syndrome

189
Q

What is the Tx for Sailadenitis?

A
  • warm compresses
  • lemon drops
  • hydration
  • gland massage
  • antibiotics
190
Q

What is Sialolithiasis?

A
  • stone formation in the salivary gland duct
  • WHARTON’S DUCT : submandibular gland
  • Stenson’s Duct : parotid gland
191
Q

What are the S/Sx of Sialoithiasis?

A
  • postprandial pain

- local swelling

192
Q

What diseases cause bilateral parotid gland enlargement?

A
  • Sjogren’s disease
  • sarcoidosis
  • DM
  • Alcoholism
193
Q

How frequent is Acute Epiglotitis?

A

now rare due to H. influenze vaccine

194
Q

What is the etiology for acute epiglottis?

A
  • bacterial is H. flu

- viral

195
Q

What are the S/Sx for acute epiglottis?

A
  • rapidly developing sore throat
    • Dysphagia*
    • Drooling*
    • High fever*
    • Systemic toxicity*
  • swollen, cherry-red epiglotitis
196
Q

How is acute epiglottis Dx?

A

-x-ray shows “thumb print sign”

197
Q

What is the Tx for acute epiglottis?

A

-IV antibiotics (cepaloporins) + dexamethasone

198
Q

Describe Croup.

A
  • laryngitis

- tracheobronchitis with sub glottal edema and airway obstruction

199
Q

What is the etiology of croup?

A

viruses

200
Q

What are the S/Sx of croup?

A
  • hoarseness
  • inspiratory stridor
  • brassy cough
  • worse at night
201
Q

What is the Tx for croup?

A
  • systemic and inhaled steroids
  • cold humidification
  • aerosolized racemic epinephrine may help
202
Q

What is the most common cause of hoarseness?

A

acute laryngitis

203
Q

What are the etiology for acute laryngitis?

A
  • usually viral

- follows an upper respiratory infection

204
Q

What is the Tx for Acute Laryngitis?

A

Tx is symptomatic

205
Q

What are the causes of vocal cord paralysis?

A
  • injury to recurrent laryngeal nerve : from surgery
  • Unilateral : breathy hoarseness
  • Bilateral : inspiratory & expiratory stidor
206
Q

What are the neck masses?

A
  • Brachial Cleft Cysts

- Thyroglossal Duct Cyst

207
Q

Describe a Brachial Cleft Cyst?

A

soft cystic mass along the anterior border of the sternomastoid muscle

208
Q

What is the Tx for a Brachial Cleft Cyst?

A

surgical removal to prevent recurrence or carcinoma

209
Q

Describe a Thyroglossal Duct Cyst?

A

remnant of the thyroid tissue causing a midline mass just below the hyoid bone

210
Q

What is the Tx for a Thyroglossal Duct Cyst?

A

surgical excision

211
Q

Acute sinusitis is most commonly caused by which 2 pathogens?

A
  • Strep pneumoniae

- haemophilus influenzae

212
Q

Oral herpes is best treated with systemic or topical antiviral?

A

-topical is first line. Systemic antivirals will help but are only indicated for severe cases

213
Q

A patient presents with several episodes of vertigo over the past several weeks. He has had intermittent unilateral hearing loss and a “blowing” in his ears. What is the most likely Dx?

A

Meniere’s disease

214
Q

White oral lesions which cannot be scraped off should make you thing of what Dx?

A

Oral leukoplakia

215
Q

What type of hearing loss is associated with aging?

A

Sensory

216
Q

Which is the most commonly affected sinus in acute sinusitis?

A

Maxillary

217
Q

A patient presents with a hot potato or muffled voice. What is the most likely Dx?

A

peritonsilar abscess

218
Q

What time frame are we talking about for chronic sinusitis?

A

> 3 months

219
Q

List the time of year when each of the following allergens is most prominent : pollen, grass, mold, ragweed

A
  • pollen tree and flower : spring
  • grasses : summer
  • mold and ragweed : fall
220
Q

How long should pressure be applied to Tx epistaxis?

A

15 minutes

221
Q

List four things that suggest group A beta hemolytic strep in a patient with pharyngitis?

A
  • fever
  • tender anterior cervical lymph nodes
  • exudate in the throat
  • no cough
222
Q

A child presents with an erythematous sandpaper rash should make you think of what Dx?

A

Scarlet fever

223
Q

In a patient with sensorineural hearing loss what will be the results of the Weber test?

A

patient will hear the sound louder in the unaffected ear

224
Q

List 4 complications of untreated strep throat?

A
  • Scarlet fever
  • glomerulonephritis
  • rheumatic fever
  • local abscess
225
Q

A patient presents with a round yellow ulcer in her mouth that is yellow-grey with a red halo. It is on the buccal mucosa and it is painful. What is the most likely Dx?

A

amphthous ulcers

226
Q

A patient presents with drooling, with stridor and in tripod position. What’s the Dx and how do you Tx it?

A

you Tx the epiglottis with a second or third generation cephalosporin like cefuroxime or ceftriaxone

227
Q

White oral lesions which can be scrapped off leaving punctate bleeding should make you think of what Dx?

A

oral candida

228
Q

What are the three possible Tx for peritonsillar abcess?

A
  • needle aspiration
  • I & D
  • tonsillectomy
229
Q

What virus causes mumps?

A

Paramyxovirus

230
Q

How do you Tx allergic rhinitis?

A

intranasal corticosteroid and antihistamines

231
Q

What is the Tx of choice for strep throat?

A
  • penicillin
  • amoxicillin
  • erythromycin
232
Q

A patient presents with unilateral hearing loss and a decrease in speech discrimination. She has also had difficulty with balance over the past week. What is the most likely Dx?

A

Acoustic neuroma

233
Q

Acute swelling and pain in the cheek that increases at meals. What is the most likely Dx?

A

Sailadenitis (salivary gland infection)

staph aureus

234
Q

When is watchful wanting with a Dx of acoustic neuroma an appropriate plan?

A

the tumor is very slow growing. watching a small tumor in an elderly patient is appropriate Tx.

235
Q

How do you administer the Weber hearing test?

A

tuning fork placed in the middle of the forehead

236
Q

A 14 year old field hockey player presents with a prominent adenopathy, white purple exudates in the throat and palpable spleen. What is the most likely Dx?

A

Mononucleosis

237
Q

How do you administer the Rinne hearing test?

A

place the tuning fork on the mastoid and then move it next to the ear

238
Q

Describe the result of a Weber hearing test in a patient with conductive hearing loss.

A

patient will report the sound louder in the affected ear

239
Q

An x-ray of the skull reveals coalescence of mastoid air cells. What is the most likely Dx?

A

Mastoiditis

240
Q

After 7 days of sinusitis what antibiotic would you start?

A

Amoxicillin or bactrim

241
Q

A 45 year old female complains of feeling the ground is rolling under feet at times. What is the most likely Dx?

A

vertigo

242
Q

A patient with a history of smoking presents with a new onset of hoarseness. This has been persistent for the past two weeks. What is the most likely Dx?

A

Laryngeal squamous cell carcinoma

243
Q

A patient presents with acute onset of continuous severe vertigo for the past five days. He does have a history of a URI 2 weeks ago. What is the most likely Dx?

A

Labrynthitis

244
Q

What does Kiesselach’s plexus refer to?

A

a group of vein’s in the anterior nose which bleed a lot

245
Q

Small grouped vesicles on the vermillion border should make you think of what Dx?

A

Herpes

246
Q

What is the treatment for Mastoiditis?

A

-Mastoiditis is an infection of the mastoid bone secondary to otitis media

  • Tx with IV cefazolin (Ancef)
  • Myringotomy (whole to drain the middle ear)
  • Excision of the mastoid bone if necessary
247
Q

What is the most common intracranial tumor?

A

-Acoustic Neuroma (Vestibular Schwannoma)

248
Q

Who gets an Acoustic Neuroma (Vestibular Schwannoma) ?

A

-occurs in males and females equally most often between the ages of 50 and 60

249
Q

A 52 y.o. female presents with sudden unilateral hearing loss, and vertigo, and tinnitus. What test do order and what is the likely Dx?

A
  • Dx is Acoustic Neuroma (Vestibular Neuroma)

- order an MRI with contrast

250
Q

What are the Tx options for an Acoustic Neuroma (Vestibular Neuroma)

A
  • if older than 70 observe and get an annual MRI/Contrast
  • surgical excision
  • radiotherapy
251
Q

Patient presents with intense ear pain, vesicle on the pinna, and left facial paralysis. What is the Dx and TX?

A
  • Dx is Ramsay-Hunt syndrome, which is acute peripheral facial palsy, associated otalgia and vermicelli-like cutaneous lesions (caused by the herpes zoster virus)
  • Tx is steroids, antiviral meds, and pain meds
252
Q

50 y.o. presents with progressive hearing loss in her right ear. Tympanic membrane is normal. Weber’s test lateralizes to the affected right ear. AC > BC of the left ear, on the right BC > AC. What is the Dx?

A

-conductive hearing loss, such as otosclerosiss

253
Q

14 y.o. presents with severe nosebleeds from left nostril for 2 weeks. Exam shows a large reddish-brown mass within the posterior nasal cavity. What is the mass and Dx?

A

-Dx is Juvenile angiofibraoma, a benign vascular tumor that tend to occur in postpubescent males (13-21). Patients usually present with brisk unilateral epistaxis and biopsy is done if necessary in OR due to risk of hemorrhage.

254
Q

What nasal condition if found in young kids is suggestive of cystic fibrosis?

A
  • nasal polyps

- get a sweat chloride test to confirm Dx of cystic fibrosis

255
Q

Which is the most common site of epistaxis in adults?

A
  • anterior septum from Kiesselbach plexus
  • Tx: pinching the nose firmly, sitting upright, leaning slightly forward is helpful. Site of bleeding should be sought with a nasal speculum, topical nasal decongestant, and effective light source. Once bleeding site is located it should be cauterized with a silver nitrate stick.
256
Q

In order, what are the three most common causes of chronic cough in adults?

A
  • Post nasal drip syndrome (PNDS)
  • asthma
  • gastroeosphageal reflux
257
Q

Elderly lady presents with slurred speech. When she sticks her tongue out it deviates to the right. Which cranial nerve is involved?

A
  • Cranial nerve XII, Hypoglossal

- increase in muscle tone of the innervated portion of the tongue pushes it to the weaker (contralateral side)

258
Q

14 y.o. boy presents with unilateral tonsilitis. The tonsil has much increased in size since his visit 5 wks ago when he was tx for tonsillitis with amoxicillin. Exam shows enlarged right tonsil and ipislateral cervical adenopathy. What do you not want to miss and what do you do with him.

A
  • dont miss Lymphoma or squamous cell carcinoma

- send to ENT for tonsilectomy and biopsy

259
Q

What ear drop antibiotic should you avoid if there is a chance of perforated tympanic membrane?

A

-do not give Neomycin preparations with a perforated typmpanic membrane as it can be neuro-ototoxic.

260
Q

Otitis in a child with swelling behind the ear and a protruding ear, along with fever needs what tx?

A
  • emergent referal to ENT
  • extension of the infection from the middle ear to the mastoid air cells can lead to acute mastoiditis. Facial nerve can become inflamed and cause facial paresis.
261
Q

24 y.o. presents with acute right facial paralysis. She awoke with this along with discomfort behind her right ear and weakness of her face. Exam in Normal. What is the Dx and tx?

A
  • Dx is Bell’s Palsy (CN VII, the facial nerve)

- Tx is 10 day course of tapering dose steroids and antiviral meds as Bell’s Palsy usually caused by a virus

262
Q

Complaints of the bed spinning when turning in bed. Patient also has complaints of spinning occasionally when he turns his head to the right. What is the likely Dx?

A
  • paroxysamal positional vertigo

- (use the Dix-Hallpike maneuver to check for positonal vertigo)

263
Q

Acute vestibular neuronitis and labyrinthitis are caused by what?

A

-Caused by viruses

  • they cause temporary vertigo
  • movement does not cause this vertigo
264
Q

Central vertigo with associated unilateral hearing loss?

A

-acoustic neuroma on the VII cranial nerve

265
Q

18 y.o. boy with hot potato voice, 4 days of sore throat and getting worse, pain with swelling and difficulty opening mouth. Dx?

A

-retropharyngeal abscess

266
Q

The four Sx/sx of Acute Bacterial Sinusitis (ABS) ?

A
  • purulent nasal discharge
  • maxillary tooth or facial pain (especially unilateral)
  • unilateral maxillary sinus tendernes
  • sudden worsening of symptoms after initial improvement

Ear, Nose, and Throat (2 decks)

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