Ear, Nose, Throat (p.306-317)

Question 1

What is the cause of otitis externa in swimmers?

Answer 1

Pseudomonas

Question 2

In what population might malignant otitis externa occur in? Tx? complication?

Answer 2

Pseudomonas in diabetics

Tx: aggressive IV antibiotics with surgical debreidment if necessary to prevent progression to mastoiditis

Question 3

What are the 2 mc causative agents for fungal otitis (otomycosis)? Tx?

Answer 3

Candida or Aspergillus

Tx: acetic acid ear drops, nystatin, triamcinilone ointment to canal

Question 4

What is Ramsay hunt syndrome?

Tx?

Answer 4

herpes zoster oticus caused by reactivation of VZV in the geniculate ganglia

Tx: acyclovir to prevent progression to meningitis and facial nerve palsy

Question 5

What is gradenigo syndrome?

Tx?

Answer 5

osteomyelitis of the petrous apex of the bone causing ipsilateral otorrhea, eye pain and abducens paralysis (CN VI)

Tx: refer

Question 6

How do you diagnose and treat tinnitus?

Answer 6

Dx: obstain audiogram to assess hearing thresholds
Tx: underlying cacuse, hearing aids may help

Question 7

Sudden episodic vertigo with head movement lasting for seconds. Dx?Tx?

Answer 7

Benign positional vertigo

Tx: eply maneuver

Question 8

Dilation of membranous labyrinth resulting from excess endolymph. Traid: aural fullness (hearing loss), tinnitus, episodic vertigo lasting few hours.Dx? Tx

Answer 8

Menieres disease

Tx: low sodium, caffeine diet

Question 9

Preceded by viral respiratory illness. vertigo lasts days to weeks. Dx?Tx?

Answer 9

Viral labrynthitis

Tx: meclizine

Question 10

CN VIII schwannoma, commonly affects vestibular postion, but can also affect cochlea. How to dx? What is Dx? Tx?

Answer 10

Acoustic neuroma
MRI of cerebellopontine angle
tx by excision

Question 11

Why does sensoineural hearing loss occur?

Answer 11

secondary to damage of the organ of corti in the cochlea or retrocochlear damage from acoustic neuroma or other CN VIII damage.

Question 12

Is senorineural hearing loss slow or acute?

Answer 12

Usually slow

Question 13

Define presbycusis

Answer 13

gradual loss of high frequency hearing loss

Question 14

What should you do in the case of sudden hearing loss?

Answer 14

Emergency - immediate ENT referral

Question 15

What is b/l hearing loss commonly due to?

Answer 15

drugs- loop diuretics, aminoglycosides, salicylates and cisplatin

Question 16

Pt with sensorineural hearing loss, lens dislocation and hematuria. Dx? Pathology?

Answer 16

Alport syndrome

Thinning of glomerular basement membrane and glomerulonephritis resulting in hematuria

Question 17

What are some congenital infectious causes of hearing loss?

Answer 17

CMV, rubella, syphillis

Question 18

What is the etiology of conductive hearing loss?

Answer 18

due to damage or obstruction affecting middle ear or external ear.

Question 19

What is the Weber test? What does it indicate?

Answer 19

vibrating tuning fork placed in midline of head

Lateralization to one ear>other ear indicates ipsilateral conductive loss or contralateral sensorineural loss

Question 20

What is Rinne’s test?

Answer 20

Vibrating tuning fork placed next to ear then againsts mastoid process. Normally, air conduction should last twice as long as bone conduction

Question 21

Whats a positive rinne test?

Answer 21

air conduction is heard longer and louder than bone conduction (this is normal)

Question 22

What is a negative rinne test?

Answer 22

bone conduction is heard longer than air conduction indicating conductive hearing loss in that ear.

Question 23

A graphic representation of a pt’s pure tone response to various auditory frequencies is called…

Answer 23

audiogram

Question 24

Which part of nose is most commonly involved in epistaxis?

Answer 24

nasal septum

Question 25

what vasculature bundle to 90% of nose bleeds occur at?

Answer 25

Kiesselbach’s plexus in anterior nasal septum

Question 26

Where do most bleeds occur in elderly (anterior or posterior)?

Answer 26

posterior

Question 27

What is the number 1 cause of epistaxis in kids?

Answer 27

trauma

Question 28

Whats the tx for epistaxis?

if that doesnt work

and if that doesnt work?

Answer 28

direct pressure, topical nasal vasoconstrictors like metazoline, phenylephrine or silver nitrate cautery

anterior packing

surgical ligation of the internal maxillary artery, ethmoidal artheries.

Question 29

Topical vasoconstrictors are contrindicated in what kind of patients ?

Answer 29

pts with HTN

Question 30

What is the most common sinus involved in sinusitis? what to check?

Answer 30

Maxillary

Check CT to show inflammatory changes or bone destruction

Question 31

Loculation of pus in the space between tonsil and superior constrictor

Answer 31

Peritonsillar abscess

Question 32

Whats another name for a peritonsillar abscess?

Answer 32

Quinsy

Question 33

Pt with fever, drooling, odynophasia, trismus and muffled voice. Uvula is displaced. dx? tx?

Answer 33

peritonsillar abscess

airway stabilization, incision and drainage

Question 34

Sinusitis chart

Answer 34

p. 314

Question 35

What is lemierre’s syndrome?

Answer 35

thrombophlebitis of the internal jugular vein.

Question 36

What is lemierre’s syndrome usually secondary to?

Answer 36

infection with anaerobic gram negative robs called Fusobacterium necrophorum

Question 37

An abscess formed from breakdown and necrosis of englarged lymph nodes in retropharyndeal space

Answer 37

retropharyngeal abscess

Question 38

What is Ludwig’s angina

Answer 38

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

Question 39

How do you diagnose Ludwig’s angine? Tx?

Answer 39

Dx by CT of face and neck demonstrating drainable collection of diffuse edema and focal point of infection.

Question 40

Pt with rough quality of voice? Doctor word for this..?

Answer 40

dysphonia (hoarseness)

Many causes see p.317

Question 41

Ethics/Law and Clinical studies cards…look at high lighted portions

Answer 41

p. 479 - 494