Ear, Nose, Throat (p.306-317) Flashcards
What is the cause of otitis externa in swimmers?
Pseudomonas
In what population might malignant otitis externa occur in? Tx? complication?
Pseudomonas in diabetics
Tx: aggressive IV antibiotics with surgical debreidment if necessary to prevent progression to mastoiditis
What are the 2 mc causative agents for fungal otitis (otomycosis)? Tx?
Candida or Aspergillus
Tx: acetic acid ear drops, nystatin, triamcinilone ointment to canal
What is Ramsay hunt syndrome?
Tx?
herpes zoster oticus caused by reactivation of VZV in the geniculate ganglia
Tx: acyclovir to prevent progression to meningitis and facial nerve palsy
What is gradenigo syndrome?
Tx?
osteomyelitis of the petrous apex of the bone causing ipsilateral otorrhea, eye pain and abducens paralysis (CN VI)
Tx: refer
How do you diagnose and treat tinnitus?
Dx: obstain audiogram to assess hearing thresholds
Tx: underlying cacuse, hearing aids may help
Sudden episodic vertigo with head movement lasting for seconds. Dx?Tx?
Benign positional vertigo
Tx: eply maneuver
Dilation of membranous labyrinth resulting from excess endolymph. Traid: aural fullness (hearing loss), tinnitus, episodic vertigo lasting few hours.Dx? Tx
Menieres disease
Tx: low sodium, caffeine diet
Preceded by viral respiratory illness. vertigo lasts days to weeks. Dx?Tx?
Viral labrynthitis
Tx: meclizine
CN VIII schwannoma, commonly affects vestibular postion, but can also affect cochlea. How to dx? What is Dx? Tx?
Acoustic neuroma
MRI of cerebellopontine angle
tx by excision
Why does sensoineural hearing loss occur?
secondary to damage of the organ of corti in the cochlea or retrocochlear damage from acoustic neuroma or other CN VIII damage.
Is senorineural hearing loss slow or acute?
Usually slow
Define presbycusis
gradual loss of high frequency hearing loss
What should you do in the case of sudden hearing loss?
Emergency - immediate ENT referral
What is b/l hearing loss commonly due to?
drugs- loop diuretics, aminoglycosides, salicylates and cisplatin
Pt with sensorineural hearing loss, lens dislocation and hematuria. Dx? Pathology?
Alport syndrome
Thinning of glomerular basement membrane and glomerulonephritis resulting in hematuria
What are some congenital infectious causes of hearing loss?
CMV, rubella, syphillis
What is the etiology of conductive hearing loss?
due to damage or obstruction affecting middle ear or external ear.
What is the Weber test? What does it indicate?
vibrating tuning fork placed in midline of head
Lateralization to one ear>other ear indicates ipsilateral conductive loss or contralateral sensorineural loss
What is Rinne’s test?
Vibrating tuning fork placed next to ear then againsts mastoid process. Normally, air conduction should last twice as long as bone conduction
Whats a positive rinne test?
air conduction is heard longer and louder than bone conduction (this is normal)
What is a negative rinne test?
bone conduction is heard longer than air conduction indicating conductive hearing loss in that ear.
A graphic representation of a pt’s pure tone response to various auditory frequencies is called…
audiogram
Which part of nose is most commonly involved in epistaxis?
nasal septum
what vasculature bundle to 90% of nose bleeds occur at?
Kiesselbach’s plexus in anterior nasal septum
Where do most bleeds occur in elderly (anterior or posterior)?
posterior
What is the number 1 cause of epistaxis in kids?
trauma
Whats the tx for epistaxis?
if that doesnt work
and if that doesnt work?
direct pressure, topical nasal vasoconstrictors like metazoline, phenylephrine or silver nitrate cautery
anterior packing
surgical ligation of the internal maxillary artery, ethmoidal artheries.
Topical vasoconstrictors are contrindicated in what kind of patients ?
pts with HTN
What is the most common sinus involved in sinusitis? what to check?
Maxillary
Check CT to show inflammatory changes or bone destruction
Loculation of pus in the space between tonsil and superior constrictor
Peritonsillar abscess
Whats another name for a peritonsillar abscess?
Quinsy
Pt with fever, drooling, odynophasia, trismus and muffled voice. Uvula is displaced. dx? tx?
peritonsillar abscess
airway stabilization, incision and drainage
Sinusitis chart
p. 314
What is lemierre’s syndrome?
thrombophlebitis of the internal jugular vein.
What is lemierre’s syndrome usually secondary to?
infection with anaerobic gram negative robs called Fusobacterium necrophorum
An abscess formed from breakdown and necrosis of englarged lymph nodes in retropharyndeal space
retropharyngeal abscess
What is Ludwig’s angina
severe celullulitis that usually originates in an infected tooth root and spreads along the floow of the mouth and eventually into the neck causing airway compromise
How do you diagnose Ludwig’s angine? Tx?
Dx by CT of face and neck demonstrating drainable collection of diffuse edema and focal point of infection.
Pt with rough quality of voice? Doctor word for this..?
dysphonia (hoarseness)
Many causes see p.317
Ethics/Law and Clinical studies cards…look at high lighted portions
p. 479 - 494
