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PANCE Review > Ear, Nose, and Throat > Flashcards

Ear, Nose, and Throat Flashcards

1
Q

viral sinusitis - sxs, dx, tx

A

common cold

Sxs: clear rhinorrhea, nasal congestion

  • assoc. sx of H/A. cough, sneezing
  • duration: < 10 days

PE: erythematous, engorged nasal mucosa
- non-purulent d/c (clear)

Tx: symptomatic

  • saline nasal irrigation
  • oral decongestion (pseudophedrine)
  • nasal decongestant sprays (phenylephrine) - 3 day max for rebound swelling
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2
Q

bacterial sinusitis - acute, subacute, chronic

A

acute: >1 wk and <4 wk
subacute: 4-12 wks
chronic: > 12 wks

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3
Q

acute bacterial sinusitis - sxs, dx, tx

A

resulting secondary infection of mucous in sinuses due to stasis

sxs lasting > 10 days or worsening sxs after initial improvement

  • facial PAIN
  • PURULENT d/c
  • fever

dx: clinical at first
- imaging if complications or not improving with ABX tx (CT prefered)

tx:
- AMOX: 7-10 days
- Macrolide (erythromycin, azithromycin) if PEN allergy
- Fluoroquinolones (Levaquin) if recent ABX or tx failure

Also supportive care w/ NSAIDS, etc.

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4
Q

chronic sinusitis

A

sinusitis lasting > 12 weeks

tx:

  • intranasal corticosteroids (fluticasone)
  • longer AMX tx: doxycycline (3 wls)
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5
Q

allergic rhinitis - sxs, tx

A

personal hx of atopy, seasonal

sxs: congestion, clear rhinorrhea
- EYE irritation (pruritus), sneezing
- cobble-stoning of posterior pharynx
- darkening under eyes

Tx:

  • avoid allergen
  • intranasal corticosteroids (delay onset of relief of 2 wks)
  • OTC antihistmines in mean time
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6
Q

antihistamines - non-sedating vs. sedating

A

non-sedating (“-dine”)

  • loradadine, fexafenadine
  • hint: ok to dine

minimally sedating: cetirizine

sedating (“-mine”)

  • brompheniramine, chlorpheniramine
  • hint: sleep is mine
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7
Q

epistaxis - causes of anterior and posterior nasal cavity bleeds

A

nose bleed
- usually unilateral

Anterior nasal cavity (Kiesselbach plexus)

  • causes: trauma, forceful blowing, rhinitis, dryness
  • tx: direct pressure (nose clamp) and lean forward
  • also cautery, packing

Posterior nasal cavity bleed

  • assoc. w/ HTN, atherosclerosis
  • tx: posterior packing referred to ENT
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8
Q

foreign body

A

occurs in PEDS to adults who are developmentally disabled

sxs:

  • unilateral purulent nasal d/c
  • foul smelling odor
  • sneezing, bleeding, pain, mouth breathing

tx: removal, refer to ENT

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9
Q

nasal polyps

A

pale, boggy nasal mass (“grape-like” structure)
- commonly seen in pts w/ allergic rhinitis, aspirin sensitivity, asthma

Sxs:

  • unilateral
  • NOT sensitive to probing (vs. a foreign body that would be sensitive)

Tx:

  • topical corticosteroids (1-3 mo)
  • short-course oral steroids follow by topical nasal corticosteroids (severe)
  • CT is not improving - surgery
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10
Q

aphthous ulcers - definition, duration, sxs, tx

A

canker sore

  • common, found on non-keratinized mucosal surface
  • painful, shallow ulcerations surrounded by red hallow
  • last 7-10 days (painful), heal in 1-3 wks

risks: stress, acidic foods

tx: supportive
- topical corticosteroids (orabase = triamcinolone acetonide in adhesive base)

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11
Q

oral herpes simplex - definition, cause, sxs, tx

A

cold sores

  • prodromal: tingling
  • small vesicles, rupture, scab formation
  • primary infection more severe
  • recurrent on vermilion border (mild, self-limited)
  • cause: HSV-1 > HSV-2

risks: stress, infection, trauma, sun exposure

tx:

  • none or antiviral topical cream (acyclovir)
  • first episode: systemic antiviral (acyclovir, valacyclovir)

Note: prevention of frequency recurrence: suppressive therapy w/ valacyclovir QD 5-7 yrs

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12
Q

oral candidiasis (thrush)

A

painful, intermittent sores in mouth

  • creamy white patches over red mucosa
  • CAN BY RUBBED OFF

risks: dentures, immune-compromised, recent steroids or ABX
- can be initial manifestation of HIV

dx:
- clinical
- biopsy if unclear (spores on wet prep)

tx:

  • -azole (7 days)
  • clotrimazole troches
  • nystatin mouth rinse
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13
Q

oral leukoplakia - sxs, risks, dx, tx

A

white lesions caused by chronic irritation (dentures, tobacco)

  • CANNOT be scraped off
  • may be dysplasia or early squamous cell CA (ETOH or tobacco risks for SCC)

dx: biopsy or scraping

tx:
- ENT, surgical removal possible

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14
Q

acute pharyngitis - viral vs. bacterial

A 
sore throat (common)
 - viral vs. bacterial key to identify strep and tx to avoid complications

viral:
- cough, rhinorrhea w/ no tonsillar exudate

bacterial (Centor Criteria):

  • fever, tender ant. cervical nodes, NO cough, tonsillar exudate/petechiae, severe
  • score determines ABX treatment (Pen V for adults, Amox for kids) vs. culture vs. symptomatic
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15
Q

complications of strep pharyngitis

A

antibody people make to group A strep can recognize normal protein on heart valves and attack it (think it’s foreign)
- rheumatic fever (myocarditis)

Post-strep: complexes between antibody and strep antigens deposit in the kidney = glomerulonephritis

scarlet fever: bright red rash

local abscess formation

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16
Q

GAS pharyngitis - tx

A

PEN V: adults
- if PEN allergy use macrolide: erythromycin or azithromycin

Note: Amox: kids (tastes better, only BID)

NOTE: do not Rx amox if possibly EBV (mono) - RASH

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17
Q

mononucleosis (EBV) - sxs and tx

A

sxs:

  • adenopathy
  • tonsillar exudate
  • YOUNG ADULT
  • ORGANOMEGALY

1/3 of pts w/ EBV also have secondary GA/B strep pharyngitis

Tx: must AVOID AMOX

18
Q

peritonsillar abscess - sxs, PE, dx, tx

A

infection that penetrate tonsillar capsule and invades surrounding tissue

sxs:
- severe sore throat, odynophagia, trismus (lock jaw), muffled voice (“hot potato”)

PE: medial deviation of soft palate and uvula

Dx: clinical; needle aspiration to confirm

Tx:

  • ABX: IV Amox in ED, PO Amox, Augmentin, Clindamcin
  • needle aspiration, I&D are controversial
19
Q

dental abscess - sxs, dx, tx

A

deep infection in periodontal tissue around tooth
- usually from untreated dental caries

Dx: clinical

Tx: refer to dentist for I&D, tooth extraction
- ABX (PEN), NSAIDS

complication: can get deep neck infection (Ludwig angina)
- emergency (airway compromise)
- tx: PEN and Flagyl (IV)

20
Q

epiglottitis - sxs, dx, tx

A

upper airway inflammation and obstruction

  • can occur at any age
  • most common in diabetic pts

sxs: rapidly developing SORE THROAT
- odynophagia (painful swallow) out of proportion to exam
- fever, drooling, voice change, sniffing position (try to get air in)

Dx: clinical
- thumbprint sign on lateral neck x-ray

Tx:

  • ADMIT (airway obs)
  • IV ABX (broad spectrum cephalosporin)
  • corticosteroids
  • prophylactic intubation may occur (PEDS)
21
Q

laryngitis - sxs, tx, cancer hints

A

most common cause of HOARSENESS

  • occurs 1 wk following URI
  • difficulty talking
  • cough
  • usually viral

Tx: conservative
- rest, fluids

Laryngeal squamous cell carcinoma

  • new, persistent hoarsness (> 2wks) & smoker
  • pain, hemoptysis, issue swallowing
  • dx: laryngoscopy and biopsy
  • tx: radiation, surgery, chemo (if advanced)
22
Q

sialadenitis - definition and cause / location

A

inflammation of salivary gland - most common parotid (cause: MUMPS; location: inner cheek near maxilla 2nd molar) and submandibular (cause: stones; location: under tongue)
- ductal obstruction leads to salivary stasis and infection

23
Q

sialadenitis - presentation, tx

A

occurs in setting of dehydration or chronic illness (Sjogren syndrome)

  • acute swelling of gland
  • postprandial pain

Tx:

  • ABX (PO Augmentin; IV nafcillin)
  • inc. salivary flow: hydration, sucking on lemon drops
24
Q

parotitis - cause, sxs, dx, tx

A

cause: MUMPS (paramyxovirus)
- often occurs in dorms, sports teams

sxs:
- prodromal sxs: malaise, HA, anorexia, fever
- swelling of parotid gland area
- earache, jaw tenderness, ear lobe lifted forward

dx: clinical (can confirm w/ labs)

tx: supportive care
- isolation (5 days); recovery 1-2 wks

25
hematoma of external ear - cause, sxs, dx, tx
cause: trauma or blunt force to ear sxs: tender auricle, fluctuant collection of blood, ecchymosis dx: clinical tx: - drain and packing - referral to ENT if lasting >1 wk complication: cauliflower ear
26
hearing impairment - 3 types
conductive: problem of external or middle ear affects sound getting to inner ear - cause: obstruction (cerumen impaction), infection - tx: correctable w/ medical or surgical tx sensory (sensorineural): due to cochlear deterioration - gradual, high frequency loss, occurs w/ aging (presbyacusis), noise, trauma - tx: NOT correctable, but can be stabilized or prevented neural: lesions of nerve or neural pathway in CNS - acoustic neuroma, MS
27
hearing impairment - testing
Weber: test for lateralization - normal: heard equal in both ears Rinne: compares air conduction and bone conduction - normal: air conduction heard longer than bone conduction conductive loss: - Weber lateralizes to impaired ear - Rinne shows BC>AC in impaired ear sensorineural loss: - Weber lateralizes to better ear - Rinne shows AC>BC in both ears
28
cerumen impaction
obstruction of canal by cerumen - hearing loss (unilateral) - itchy, painful tx: removal - ear drops (debrox) - curette - irrigation
29
eustachian tube dysfunction
normally closed and opens only during yawn or swallow dysfunction: air trapped in middle ear causes negative pressure - usually from viral URI or allergy sxs: fullness, hearing fluctuation, discomfort w/ barometric changes tx: systemic and intranasal decongestants - pseudoephedrine - oxymetazoline spray
30
barotrauma - definition, sxs, tx
injury caused by changes in atmospheric pressure - occurs w/ eustachian tube dysfunction during air travel, diving, altitude change sxs: pain, hearing loss tx: - decongestants prior to episode - swallow, yawn - myringotomy (small eardrum perforation) if severe
31
tympanic membrane perforation - cause
causes: trauma to middle ear, pressure changes, chronic otitis media, iatrogenic (during foreign body removal) sxs: - sudden ear pain that suddenly gets better - see tear on otoscopic exam tx: - most heal spontaneously - ENT can follow - avoid water exposure (swimming, etc.) - ABX - only if caused by AOM
32
cholesteatoma
trapped skin from eustachian tube dysfx causes white mass behind TM - will keep growing so much remove - key: differentiate from tympanosclerosis (scar from PE tubes) - benign tx: REFER! - surgical removal
33
mastoiditis
inflammation of mastoid air cells inside mastoid process - occurs weeks after otitis media that was inadequately treated - more common in kids sxs: postauricular pain, erythema, fever, forward auricular displacement dx: clinical tx: IV ABX (cefazolin) - myringotomy (TM incision for drain/culture) - surgical drainage or mastoidectomy (w/ med failure)
34
tinnitus
perceived sound in absence of exogenous sound source - often indicates sensorineural hearing loss dx: - non-pulsatile: audiometry to r/o hearing loss - unilateral: MRI to r/o vestibular schwannoma - Pulsatile: MRA and venography to r/o vascular lesion tx: - avoid: excessive noise, ototoxic agents, trauma - find and treat cause
35
vertigo - definition and hx components
sensation of motion when there is no motion or only small motion (exaggerated) - spinning, tumbling, falling History differentiates peripheral vs. central - duration of episodes - associated hearing loss - triggers: ETOH, stress, high salt diet (Meniere dz)
36
vertigo - peripheral vs. central causes | - limit to those on blueprint
peripheral: - labyrinthitis - Meniere disease - Benign positional vertigo (Dicks-Hallpike) (not on blue print) mixed central and peripheral: - vestibular schwannoma - migraine, infection (not on blue print) central: MS, seizures, Wernicke encephalopathy - none on blue print
37
peripheral vertigo - origin, sxs
otologic origin sxs: - sudden onset - tinnitus and hearing loss - N/V - horizontal nystagmus w/ rotary component - unidirectional - suppressed by visual fixation
38
central vertigo - sxs
CNS origin sxs: - gradual onset - NO auditory sxs - nonfatiguable vertical nystagmus - NOT suppressed by visual fixation
39
Meniere's disease - definition, 4 clinical findings, PE, tx
increased volume of endolymph (fluid) in ear causes pressure changes 4 findings: - episodic vertigo: minutes to hours - hearing loss - tinnitus: low pitched blowing - unilateral aural pressure PE: - horizontal nystagmus - unilateral hearing loss tx: lower pressure - low salt diet - diuretics sx relief w/ meclizine or valium
40
labyrinthitis - clinical findings, cause, tx
peripheral vertigo: - acute onset, continuous, severe - lasts days to weeks - hearing loss, tinnitus - takes weeks to improve cause: unknown, following URI Tx: bed rest
41
acoustic neuroma - 8th CN schwannoma - definition, sxs, dx, tx
common intracranial tumor - BENIGN sxs: - unilateral hearing loss - dec. speech discrimination - continuous disequilibrium dx: MRI tx: depends on patient's age and tumor size

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