EENT (PEARLS and BOARD REVIEW) Flashcards
Recurrent painful inflammation of the cartilage of the external auricle.
Polychondritis
How do you tell whether it’s polychondritis or cellulitis?
The lobule is NOT involved in polychondritis.
How do you treat polychondritis?
Prednisone (steroid)
Bacteria that causes otitis externa are likely what?
GRAM negative rods (pseudomonas, proteus)
How do you treat OE?
abx/steroid drops (be careful with neomycin because it can cause ototoxicity if the eardrum is ruptured).
What do you treat resistant OE with?
Fleuroquinolones (Cipro)
A pt has retracted TM with decreased mobility of the TM. They feel aural fullness, hearing issues, popping/clicking noises, and discomfort with pressure changes. What is this? How might you treat it?
Auditory tube dysfunction. Treat for rhinitis (decongestant)
Treatment for serous otitis media?
Short course of oral steroids
What is your biggest concern if you find hemotympanum?
Basilar skull fracture
Traumatic TM perforations treatment?
Usually resolve. Can consider ABX (water caused, etc). and referral.
Top causes of acute OM
Strep pneumo/pyogenes, h. flu, mycoplasma
Main complication of untreated/unresolving acute OM
Mastoiditis or osteomyelitis
Treatment for acute OM
Amoxicillin or erythromycin. Consider decongestant.
Treatment for acute OM if unresolved with abx or if recent abx
Augmentin.
A pt presents with post auricular pain, swelling, erythema, and fever. Had recent OM
Acute mastoiditis
What is the classic physical feature of acute mastoiditis?
Displacement of pinna anteriorly.
Tx for acute mastoiditis?
IV abx, myringotomy for culture and drainage, possible complete mastoidectomy.
What if a pt you suspect has had a recent bout of acute mastoiditis presents with signs of increased ICP?
Possible septic thrombophlebitis due to trapped infection within the mastoid air cells.
Green drainage from ruptured TM.
Pseudomonas
Complication of chronic OM
Cholesteatoma.
Tx for chronic OM
Topical abx, oral floxin, keep ears dry, may need surgical reconstruction.
What is it when a person has auditory tube dysfunction which causes a negative pressure drawing the upper portion of the TM inward creating a sac lined with epithelium?
Cholesteatoma
Should you refer a cholesteatoma?
Yes
Weber test lateralization to one ear means what?
Either conductive loss in LOUD ear or sensorineural loss in OTHER ear. (Can’t hear same ear or Sucky Senses other ear)
Rinne Test explanation.
Should hear (conductive) sound 2 x longer than hear (sensorineural) sound. AC > BC is normal UNLESS there is > 2:1 ratio. If it is MORE than 2:1, there may be sensorineural loss. If BC > AC then loss may be conductive.
T/F. Sensorineural hearing loss is usually symmetric.
TRUE
What is the most common type of sensorineural hearing loss?
Presbycusis (age related hearing loss)
What CN is affected by a acoustic neuroma?
8th cranial nerve
Another name for an acoustic neuroma?
Vestibular schwannoma
A pt has unilateral hearing loss, loss of speech discrimination, tinnitus, and chronic disequilibrium.
Acoustic neuroma
Meniere syndrome. Another name? Lasts? Sx? Test? Tx?
Endolymphatic hydrops, lasts 1-8 hours, fluctuating low frequency hearing loss, cold water calorics testing shows alteration of nystagmus on AFFECTED side, treat with low sodium diet, thiazide diuretics, antiemedics (for nausea)
Acute labyrinthitis. Lasts? Sx? Situation? Tx?
Acute onset of continuous severe vertigo lasting days to a week. Accompanied by hearing loss and tinnitus. Often follows a URI. Treat with antihistamines, anticholinergics, sedative-hypnotics.
Free floating otoconia in the semicircular canal.
BPPV
T/F. Acute vertigo with BPPV usually only lasts a few seconds to a minute but pts can feel unbalanced or hours.
TRUE
Maneuvers for treating BPPV
Epley maneuvers
Where does anterior epistaxis usually originate from?
Kiesselbach’s plexus
What causes nasal vestibulitis?
This is cellulitis or folliculitis of the hairs within the nasal vestibule. Usually staph a.
A black necrotic eschar found in the nose.
Rhinocerebral mucormycosis
What is it when a deadly fungus invades through the vascular channels?
Rhinocerebral mucormycosis
You see “cobblestoning” down the throat and have a patient with allergic shiners, and pale/violaceous mucosa
Allergic rhinitis
A pt has pale, boggy masses of hypotrophic tissue that looks a lot like “peeled grapes”
Nasal polyposis
When do you commonly see nasal polyposis
With allergic rhinitis
A pt with a history of asthma AND nasal polyposis. What are you thinking with regard to allergies? What triad is this?
Allergy to ASA! Samter triad.
What is the treatment for nasal polyposis?
Intranasal steroids for 1-3 months
Most common causes of viral rhinitis/rhinosinusitis
Adenovirus, rhinovirus.
What can overuse of decongestions cause?
Rhinitis medicamentosa
How often can parents expect to have their child get a URI per year?
6 episodes.
How often do adults get URI’s each year?
1-3 episodes.
URI symptoms that persist >7-10 days.
Sinusitis
Sx of sinusitis
UNILATERAL pain over the maxillary sinus, toothache, fever, swelling, watery/purulent discharge .
What type of image should you perform for a dx of sinusitis?
Coronal CT. NOT sinus XR
Guidelines for treatment of sinusitis?
Sx persistent or unimproved > 10 days, severe for > 3-4 days, or double sick > 3-4 days
Tx for sinusitis
Augmentin, amox, or 1st gen ceph.
Parameters of subacute chronic sinusitis
Persist 4-12 weeks LESS than 4 x yearly
Parameters of subacute chronic sinusitis
Persist more than 4 weeks more than 4 x yearly
A pt named YOUNG PERSON name VINCENT comes in with halitosis, bleeding, gum pain, and fever.
Acute necrotizing gingivitis aka VINCENT gingivostomatitis
Acute necrotizing gingivitis aka VINCENT gingivostomatitis is caused by what bacteria?
Borrelia or fusobacterium
Treatment for acute necrotizing gingivitis aka VINCENT gingivostomatitis
Oral PCN, peroxide rince, gingival curettage.
A pt has hoarseness for > 2 weeks, persistent throat/ear pain, neck mass, hemoptysis, stridor. What do you want to do?
CT or MRI asap. Biopsy at laryngoscopy. Concern for squamous cell carcinoma of the pharynx.
What STI is associated with oral cancers?
HPV
What is the most common malignancy of the pharynx?
Squamous cell carcinoma
What is the most common cause of sore throat?
Viral pharyngitis
A pt with fever, tender cervical lymph nodes, NO cough, tonsilar exudates.
Group A beta h. strep pharyngitis
A pt has a odynophagia, trismus (tight jaw), severe soar throat, “hot potato” voice.
Peritonsilar abscess. May also have medial deviation of soft palate.
Treatment for peritonsilar abscess.
Aspirate, I&D, abx (IV or oral), tonsillectomy
What will you see with mono?
Marked lymphadenopathy, occipital nodes, “shaggy” tonsilar exudate, severe fatigue, splenomegaly.
How should you test for mono?
Monospot or elevation in anti EBV.
What other pathology do 1/3 people with mono have?
Strep
What medication should be avoided in treating somebody with mono and strep?
Ampicillin
What activities should be avoided if a pt has mono?
Contact sports
Pt presents with sore throat, nasal discharge, and malaise. You notice tenacious gray membranes on his pharynx.
Diphtheria
What is the concern with diphtheria?
Exotoxin production that can cause myocarditis/neuropathy.
Sialothiasis are what?
Calculus formations in the Wharton and Stensen ducts.
Sialadenitis is what?
Bacterial infection of a salivary gland.
Most common etiology of sialadenitis?
Staph aureus.
Parotitis is commonly seen in what other diseases?
Metabolic disorders, sjogrens, etOH, sarcoidosis, DM
Grayish/white, irregular hyperkeratotic plaques.
Leukoplakia
Velvety-red hyperkeratotic plaques.
Erythroplakia
Which can progress to squamous cell cancer? Leukoplakia or Erythroplakia?
Erythroplakia.
Most common oral cancer?
Squamous cell
Most lip cancers occur on the top/bottom lip?
Bottom.
Half all intraoral cancers occur on the…?
Tongue
What is the deep neck infection/cellulitis of the sublingual and/or submandibular spaces?
Ludwig Angina
Most common offending organisms in Ludwig angina
Strep, staph
Most important intervention with Ludwig angina.
Emergency!!! These patients with have fever, edema of the upper neck, possible airway obstruction by displacement of tongue.
A pt has a soft cystic mass on the ANTERIOR BORDER of the sternocleidomastoid (lateral neck).
Brachial cleft cyst
A pt has a soft cystic mass on the MIDLINE of the neck that MOVES with swallowing.
Thyroglossal duct cyst
Tx for brachial cleft cysts and thyroglossal duct cysts?
ABX and surgical removal of cyst.
Painful swollen red lump on eyelid. What? Etiology? Treatment?
Hordeolum caused by STAPH A. Treat with warm compress. May add erythromycin or bacitracin ointment if actively draining. I&D if it doesn’t drain within 48 hours.
Inflammation of BOTH eyelids with crusting, scaling, RED RIMMING and eyelash flaking.
Blepharitis. If it’s ANTERIOR it will involved the eyelashes. If it’s POSTERIOR it will involved the meibomian gland.
How would you treat blepharitis?
Anterior = warm compresses, eye hygiene, scrubbing with baby shampoo and/or applying abx ointment. Posterior = Eyelid massage. Express the meibomian gland regularly.
Hard NON TENDER eyelid swelling with large firm granuloma. What is it? What will you do?
Eyelid hygiene, warm compresses. May inject steroids in large ones
Tender, redness, swelling to nasal side of lower eyelid. What is it? Cause? Treatment?
Dacrocystitis. Caused by Staph A, GABHS. Treat with systemic abx (clindamicin or 3rd gen ceph)
