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Pance Re-Up > EENT Precision & Pearls #3 (Nose & Throat) > Flashcards

EENT Precision & Pearls #3 (Nose & Throat) Flashcards

1
Q

Anterior epistaxis:
-Causes
-MC Location
-Order of treatment options

A

-Nasal trauma (nose picking), dry weather, alcohol, antiplatelet medications, cocaine use

-Kiesselbach Plexus

-Direct pressure 5-15 minutes (leaning forward) + Topical Vasodilators (Oxymetazoline, Lidocaine)
–Cauterization
–Nasal packing

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2
Q

Posterior epistaxis
-Causes
-MC Location
-Order of treatment options

A

-Hypertension, atherosclerosis, older age, neoplasms

-Sphenopalatine artery and Woodruff’s Plexus

-Balloon catheters
-Posterior packing and admission

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3
Q

Rhinitis is inflammation of the nasal mucosa. Symptoms of this condition include…

There are three types. Name them.

A

Allergic: MC type (IgE mediated)
Infectious: Rhinovirus
Vasomotor: due to temp or smells

Allergic: pale, boggy turbinates, nasal polyps. Cobblestone mucosa of conjunctiva. Allergic shiners, allergic salute

Viral/Infectious: Erythematous turbinates

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4
Q

What is the treatment for allergic rhinitis?

A

Intranasal corticosteroids (Mometasone, Fluticasone)
Antihistamines or decongestants

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5
Q

Treatment for vasomotor rhinitis

A

-Oral antihistamines, decongestants, intranasal steroids

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6
Q

What should you be aware of when using intranasal corticosteroids most than 3-5 days

A

Rhinitis medicamentosa = rebound congestion

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7
Q

Common causes of nasal polyps

A

Allergic rhinitis and cystic fibrosis

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8
Q

Explain what a nasal polyp looks like and the treatment

A

Pale, boggy mass on nasal mucosa

Intranasal glucocorticoids

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9
Q

What are nasal polyps associated with?

A

Samter’s Triad: nasal polyps + asthma + aspirin sensitivity

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10
Q

Acute sinusitis has viral and bacterial causes. What are the MCC in both categories?

A

Viral: Rhinovirus
Bacterial: Strep Pneumo

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11
Q

Symptoms of acute sinusitis

A

Facial pain worse with bending or leaning
Headache, fever, purulent nasal discharge
Worsening symptoms after period of improvement (especially bacterial)

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12
Q

What diagnostics are done for acute sinusitis?

A

CT scan without contrast (DOC)
XR Sinus: Water’s View
Biopsy: definitive

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13
Q

Treatment for acute sinusitis

A

-Supportive, decongestants
-ABX only if symptoms > 10 days, worsening symptoms
–Augmentin, Amoxicillin are first line
–Doxy or Bactrim 2nd line

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14
Q

Chronic sinusitis is when the symptoms last ________ and the diagnostic that should be done is

A

> 12 weeks

Biopsy or histology to determine causative organism

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15
Q

MC bacterial cause of chronic sinusitis
MC fungal cause of chronic sinusitis

A

Staph A
Aspergillus

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16
Q

Mucormycosis (Zygomycosis) is an invasive fungal infection of the sinuses, lungs, and CNS. Who is this MC seen in?

Name some symptoms of this rare condition.

A

Immunocompromised or Diabetics

Sinusitis progressing to orbit and brain involvement. May have black eschar on palate, nasal mucosa, or face

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17
Q

Diagnostics for mucormycosis

A

-Biopsy: non-septate broad hyphae with irregular right angle branching

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18
Q

Treatment for mucormycosis

A

-IV Amphotericin B and debridement of necrotic areas

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19
Q

Symptoms of a nasal foreign body

A

Epistaxis with purulent discharge, foul odor, and nasal obstruction (mouth breathing)

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20
Q

Name two ways you can remove a nasal foreign body

A

-Positive pressure
–blow nose with obstructing opposite nostril
–parent blows into the mouth while obstructing opposite nostril

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21
Q

Aphthous ulcers are canker sores, essentially. What conditions are these associated with?

Describe a canker sore

A

Associated with IBD, Celiac, SLE, HIV

Small, painful shallow round/oval (yellow, white, grey exudates) with erythematous halo

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22
Q

What is the treatment for an aphthous ulcer?

A

Topical oral glucocorticoids (Clobetasol, Dexamethasone)

2% viscous lidocaine for analgesia

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23
Q

Risk factors for oral candidiasis (thrush)

Symptoms of this condition

A

Immunocompromised states, ABX use, denture use, use of inhaled corticosteroids without a spacer

Loss of taste. White curd-like plaques in mouth that are easily friable and bleed easily

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24
Q

Diagnostic done for thrush and what is seen

A

KOH prep: budding yeast and pseudohyphae of scrapings

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25
Q

Treatment for Thrush

A

-Nystatin liquid, Clotrimazole troches
-Oral Fluconazole if severe

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26
Q

Oral leukoplakia is ______ and risk factors associated with this are

A

Hyperkeratosis due to chronic irritation

-Smoking, alcohol, dentures, HPV infections

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27
Q

Symptoms of oral leukoplakia

A

-Painless, white patchy lesions that CAN’T be scraped off

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28
Q

You should perform what diagnostic and why for oral leukoplakia?

A

Biopsy to rule out squamous cell carcinoma

High chance of SCC with this

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29
Q

Treatment for oral leukoplakia

A

-Cessation of irritants
-Cryotherapy or laser ablation if high risk for SCC

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30
Q

On the other hand, oral hairy leukoplakia is a mucocutaneous manifestation of _______. The symptom of this condition are

A

-EBV (HHV4)

Painless, white, smooth or corrugated “hairy” plaque along lateral tongue border that can’t be scraped off

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31
Q

Oral hairy leukoplakia occurs almost exclusively in this with what condition?

A

HIV

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32
Q

Treatment for oral hairy leukoplakia

A

No specific treatment
Antiretrovirals for HIV treatment

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33
Q

Erythroplakia is uncommon and has a high risk of malignancy. 90% are either dysplastic or SCC. The risk factors are the same (chronic irritation); however, what does this look like?

A

Painless, erythematous soft velvety patch in the oral cavity (floor MC)

34
Q

Treatment after biopsy for erythroplakia

A

Complete excision if SCC

35
Q

Oral Lichen Planus is an idiopathic cell-mediated autoimmune response. It is associated with what condition?

Explain what this looks like MC

A

Hepatitis C infection

Lacy reticular leukoplakia of oral mucosa (Wickham Striae)

36
Q

Diagnostics for oral lichen planus and treatment

A

-Biopsy to rule out SCC

-Treatment: local glucocorticoids (Betameth, Clobetasol)
–Topical 2nd line
–Systemic 3rd line

37
Q

Parotitis is inflammation of the parotid glands. Risk factors for this include

Causes…

A

Risks: Dehydration, meds, malnutrition (anything that causes increased salivation)

Bacterial, Viral (Mumps), Autoimmune (Sjogren’s, SLE), Obstruction (Stone)

38
Q

If the parotitis is associated with mumps, what will occur?

If associated with bacterial, what will occur?

A

Mumps: Bilateral swelling

Bacterial: unilateral swelling

39
Q

Treatment for parotitis

A

-Symptomatic
-Sialogogues, Hydration
-Stone removal
-Bacterial IV ABX

40
Q

What vaccine can prevent parotitis?

A

MMR (Mumps)

at 12-15 months and 4-6 years old (in two doses)

41
Q

Acute bacterial sialadenitis (Suppurative) is a bacterial infection of the parotid or submandibular glands MCC by ________, but risk factors are ________

A

Staph A

Dehydration, stone, Sjogren’s, Autoimmune

42
Q

Symptoms of sialadenitis

A

-Sudden onset of firm, tender gland swelling with purulent discharge (pus) if duct massaged
-Dysphagia, Trismus, Fever, chills

43
Q

What diagnostic can be done to diagnose sialadenitis and what is the treatment?

A

CT scan

Sialogogues and ABX (Nafcillin or Dicloxacillin)

44
Q

What are other things you can remind the patient to avoid sialadenitis?

A

Maintain good oral hygiene, smoking cessation, increase water intake

45
Q

Sialolithiasis (Salivary Gland Stone) MC occurs in what locations?

A

Wharton’s Duct (submandibular gland) or Stensen’s Duct (parotid gland)

46
Q

Symptoms of a salivary gland stone and treatment for it

A

Sudden onset of salivary gland pain and swelling with eating or in anticipation of eating

Sialogogues, increase fluid intake, moist heat
-Laser surgery or sialoadenectomy if no relief

47
Q

Epiglottitis is a life threatening inflammation of epiglottis. It is MC in kids, but Diabetes is a risk factor in adults. What are the common causes (MC overall and if immunized)?

Symptoms of this condition?

A

H. Influenza B (MC)
Strep (GABSH) if immunized

Drooling, Dysphagia, Distress
Inspiratory stridor, dyspnea, hot potato voice, tripod position

48
Q

What two diagnostics can be done for epiglottitis and what is seen on each? What should you NOT do?

A

Lateral cervical XR: Thumbprint sign
Laryngoscopy: definitive: cherry red epiglottis with swelling

DO NOT VISUALIZE WITH TONGUE DEPRESSOR

49
Q

Treatment for epiglottitis

A

-maintain airway
-OR best for intubation, ENT consult
-IVF AND IV ABX
–Ceftriaxone or Cefotaxime
-Can add PCN or Vanco

50
Q

What can you give to close contacts of those with epiglottis?

A

Rifampin

or get the HiB vaccine

51
Q

Laryngitis, MC after a viral URI, can also be caused by what things?

What are some symptoms?

What is the treatment?

A

Vocal strain, irritations (GERD, Polyps

Hoarseness, aphonia, scratchy throat

Supportive, vocal rest, fluids

52
Q

A peritonsillar abscess (Quinsy) is MCC by what organism?

What are the symptoms?

A

Strep Pyogenes (GABHS)

-Dysphagia, hot potato voice, drooling, trismus, swollen or fluctuant tonsil
-Uvula deviation to the contralateral side

53
Q

Treatment for a peritonsillar abscess

A

Drainage (needle aspiration preferred) or I&D
-ABX: Oral Augmentin or Clindamycin

54
Q

What is angular cheilitis?

A

Fissures at the side of the mouth

55
Q

What is the first line diagnostic to use for a peritonsillar abscess?

A

CT scan to differentiate abscess from cellulitis

56
Q

MCC Of acute pharyngitis

A

Viral: Adenovirus, Rhinovirus, etc.

57
Q

Strep Pharyngitis, MCC by ______, has symptoms such as _______. Think of the Centor Criteria.

A

GABHS

Fever, Absence of cough, tonsillar exudates, anterior cervical LAD

58
Q

What diagnostics can be done for GABHS Pharyngitis?

What is one complication that should be remembered with this condition?

A

Rapid antigen detection test (best initial)
–If negative, get throat culture (definitive)

Rheumatic Fever!

59
Q

Treatment for Strep Pharyngitis

A

-Penicillin G or VK (First line), Amoxcillin
–Macrolides if PCN allergic

60
Q

What is Ludwig’s Angina?

What is it commonly from?

Symptoms of this condition?

A

Cellulitis of the floor of the mouth

Dental infections, HIV, DM

Fever, stiff neck, dysphagia, drooling, woody induration of the upper neck and chin

61
Q

What diagnostic is done for Ludwig’s Angina?

A

CT scan of the neck

62
Q

Treatment for Ludwig’s Angina?

A

IV Augmentin or Ceftriaxone + Metro
–Add Vanco if MRSA suspected

63
Q

What is acute herpetic gingivostomatitis?

Symptoms of this?

Treatment?

A

-Primary manifestation of HSV-1 in kids

Ulcerative lesions on gingiva (gum swelling, friable, bleeding)
-Perioral vesiular lesions clustered on an erythematous base with a halo

Oral Acyclovir if within 3 days of onset. Otherwise, supportive

64
Q

What are symptoms of a retropharyngeal abscess?

A

Torticollis, stiff neck with extension, fever, drooling, dysphagia

Midline/unilateral posterior pharyngeal wall edema

Anterior Cervical LAD

65
Q

What diagnostics are done for a retropharyngeal abscess, what is seen and what is the treatment?

A

Lateral neck XR: increased prevertebral space ( >50%)

CT with contrast is DOC

I&D and IV ABX: Augmentin or Clindamycin

66
Q

What is acute herpetic pharyngotonsillitis?

Symptoms and treatment

A

Primary manifestation of HSV-1 in adults

Vesicles that rupture and lead to ulcerative lesions with grayish exudate in mouth

Oral hygiene

67
Q

Respiratory Diphtheria is caused by what bacteria?

Transmission?

Symptoms?

A

Corynebacterium diphtheriae (gram positive bacillus)

Laryngitis (sore throat, fever, malaise)
Myocarditis (arrhythmias, or heart failure)
-Friable, gray to white membrane on pharynx that bleeds if scraped.
Cervical LAD (bull neck)

68
Q

Although Diphtheria is a clinical diagnosis, what can be done?

A

Culture (using Loffler medium or tellurite agar)

69
Q

Treatment for Diphtheria

A

Diphtheria antitoxin (horse serum) + Erythromycin or Penicillin x 2 weeks

70
Q

What are some things to remember about treating Diphtheria?

A

Patient in respiratory droplet isolation until 2 cultures 24 hours apart are negative

Prophylaxis for close contacts: Erythromycin or Penicillin G x 1 dose

71
Q

DTaP schedule with booster

A

5 doses at 2, 4, 6 month , between 15-18 months, and between 4-6 years old

Booster: at 11-12 years old

72
Q

Nasopharyngeal carcinoma MC type and risk factors

A

-Squamous Cell Carcinoma

-EBV, hereditary, diet rich in salted fish

73
Q

Symptoms of nasopharyngeal carcinoma

A

-Lump in neck (palpable LAD due to metastasis late in disease)
-unilateral hearing loss
-nasal obstruction
-blood tinged nasal discharge
-facial numbness
-unintentional weight loss

74
Q

One important thing to remember about naspopharyngeal carcinoma should you remember to associated with?

A

EBV –> nasopharyngeal carcinoma

75
Q

What is a mucocele?

A

Mucus filled cyst caused by trauma –> obstruction of salivary gland flow

Located on lower lip. Painless swelling in oral cavity. Bluish color.

They usually spontaneously resolve.

76
Q

More than 90% of oropharyngeal cancer/larynx cancer are _______.

Risk factors include….

A

SCC

HPV, Smoking, exposure to paint, asbestos, gasoline fumes, radiation

77
Q

Larynx Cancer symptoms

A

-Hoarseness!
-Odynophagia
-Referred ear pain
-Firm, painless mass in neck
-Weight loss
-Aspiration
-Airway compromise

78
Q

Treatment for larynx cancer

A

Surgical resection +/- chemo/radiation

79
Q

Malignant neoplasm of the mouth is almost always associated with

A

oral tobacco

80
Q

What is torus palatinus?

Treatment?

A

Harmless, painless bony growth located on the roof of the mouth (hard palate)

Only needs to be referred to maxofacial surgeon if problematic. Observation for most cases.

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