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Surgery 2 > ENT 1 > Flashcards

ENT 1 Flashcards

1
Q

What is the initial approach to ENT surgery?

A
  • HPI (OLD CARTS)
  • PMHx (thyroid disease, head and neck ca, recurrent tonsillitis or acute otitis media…).
  • PSHx (thyroidectomy, otologic surgeries, orthopedic procedure, dental procedures).
  • MEDs (antibiotics, Aspirin, chemo)
  • Allegies (seasonal and medical)
  • FHx (hearing loss, cancer)
  • SHx (oral sex, smoking, tobacco use, alcohol)
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2
Q

What does the otolarngology head and neck PE involve?

A
  • Head= battle sign, or racoon sign.
  • Eyes= ecchymosis, proptosis; bulging, ptosis…
  • Ears= tenderness, erythema, bulging, perforation, effusion.
  • Nose= torus tubarius, adenoid pad, masses…
  • Oral Cavity= dentition, floor of mouth, tongue, tonsils, lesions, swelling, trismus (painful opening of the mouth)…
  • Larynx= endoscopic exam (epiglottis, piriform sinus, vallecula; space between base of tongue and epiglottis, vocal cords)
  • Neck= masses, lesions, thyroid, ROM.
  • cranial nerve exam= 1-12
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3
Q

What is CONDUCTIVE hearing loss?

A
  • occurs due to something lateral to the oval window= EAC, TM, middle ear, r ossicles.
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4
Q

What could cause CONDUCTIVE hearing loss?

A
  • infection
  • effusion
  • otosclerosis
  • cerumen impaction (MOST COMMON in adults).
  • congenital
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5
Q

How do we diagnose CONDUCTIVE hearing loss?

A
  • weber-rinne test= BONE more than air.

- audiotympanogram

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6
Q

How do we treat CONDUCTIVE hearing loss?

A
  • correct underlying pathology

- hearing aid (BAHA vs traditional).

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7
Q

What is SENSORINEURAL hearing loss?

A
  • results from damage to the NERVE pathway (medial to the oval window).
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8
Q

What causes SENSORINEURAL hearing loss?

A
  • noise induced
  • presbycusis
  • neoplasm
  • autoimmune
  • infections (meningitis)
  • Meniere’s disease
  • congenital
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9
Q

How do we diagnose SENSORINEURAL hearing loss?

A
  • Weber-rinne test= AIR more than bone.

- audiotympanogram

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10
Q

How do we treat SENSORINEURAL hearing loss?

A
  • treat underlying pathology

- hearing aid, cochlear implant.

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11
Q

If the WEBER test (tuning fork on top of the head) lateralizes to the left and you hear it better on the left, what type of hearing loss does this indicate?

A
  • CONDUCTIVE because you hear bone conduction better than air in conductive hearing loss.
  • if you hear it better on the right, but have a normal Rinne, test, then this is sensorineural hearing loss (on the left).
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12
Q

What is otitis EXTERNA?

A
  • inflammation of the external auditory canal.

* exzematous, bacterial, fungal, malignant/necrotizing.

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13
Q

What is otitits MEDIA?

A
  • inflammation of the middle ear.

* acute, serous, or chronic.

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14
Q

What is acute otitis externa (SWIMMER’S EAR)?

A
  • infection of the skin of the external auditory canal (EAC) caused by retention of water or over cleaning, which leads to alkalotic EAC and an environment for bacterial overgrowth.
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15
Q

What pathogen is most associated with acute otitis externa?

A
  • pseudomonas aeruginosa

* staphylococcus is 2nd

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16
Q

How do we treat acute otitis externa?

A
  • cleaning and debridement of infection.
  • otic acidification drops (acetic acid), or antibiotic drops for more severe infections (ciprofloxacin).
  • AVOID aminoglycosides bc these are ototoxic!
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17
Q

How can you ensure that drops get into the EAC for acute otitis externa?

A
  • place a wick to widen the canal
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18
Q

What is otomycosis?

A
  • fungal ear infection most often caused by aspergillus.

- will see moist sheets of keratin, dotted block, white or grey membrane in EAC.

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19
Q

How do you treat otomycosis?

A
  • acetic acid
  • antifungal drops
  • gentian violet
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20
Q

What is chronic and eczematous otitis externa?

A
  • thickening and inflammation of the EAC secondary to chronic low-grade infection.
  • dry flaky, itchy EAC with mild pain
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21
Q

How do you treat chronic and eczematous otitis externa?

A
  • debride EAC
  • corticosteroid drops
  • consider derm consult
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22
Q

What is the most common cause of malignant or necrotizing otitis externa?

A
  • pseudomonas aeruginosa

* immunocompromised pts are high risk

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23
Q

What is common on PE for malignant otitis externa?

A
  • granulation tissue in the EAC at the bony-cartilaginous junction.
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24
Q

How do you diagnose malignant otitis externa?

A
  • technetium 99 bone scan and/or CT of temporal bone
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25
Q

How do you treat malignant otitis externa?

A
  • IV antibiotics
  • debridement
  • control blood sugar if diabetic.
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26
Q

What are some serious complications of malignant otitis externa?

A
  • cranial neuropathy
  • sinus thrombosis
  • intracranial infections
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27
Q

What is acute otitis media?

A
  • less than 3 weeks of inflammation of the middle ear due to negative middle ear pressure from Eustachian tube dysfunction, which leads to fluid collection in the middle ear and infection.
  • second most common disease in children
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28
Q

What are the most common causes of acute otitis media?

A
  • STREP. PNEUMONIAE= #1
  • Haemophilus influenzae
  • Moraxella catarrhalis
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29
Q

What are the risk factors for acute otitis media?

A
  • URI
  • allergic rhinitis
  • second hand smoke
  • GERD
  • adenoid hypertrophy
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30
Q

What are the PE signs for acute otitis media?

A
  • otalgia
  • hearing loss
  • feer
  • hyperemic TM
  • bulging TM
  • air-fluid level
  • may have perforation with purulent otorrhea
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31
Q

How do you treat acute otitis media?

A
  • amoxicillin or augmentin

- myringotomy tube placed for serve cases or recurrent.

32
Q

What is SEROUS otitis media?

A
  • presence of middle ear fluid WITHOUT infection.

* most common cause of pediatric hearing loss.

33
Q

What does any adult with unilateral effusion require?

A
  • nasopharyngeal exam to rule out tumors
34
Q

How do you treat serous otitis media?

A
  • treat underlying cause
  • observe 3 months
  • myringotomy tube placement after failed conservative management
35
Q

What must you worry about with chronic otitis media?

A
  • cholesteatoma= epithelial tumor that can cause bony erosion.
36
Q

What patients are at high risk for chronic otitis media?

A
  • cleft palate
  • down syndrome
  • GERD
37
Q

Will you have a maloderous otorrhea with perforated TM from chronic otitis media?

A

YES

38
Q

What are the phases of allergic rhinitis?

A
  1. primary reaction phase= type I hypersensitivity (IgE mediated) that occurs within 5 min of exposure.
  2. secondary phase= 4-6 hours later due to leukotrienes and cytokine mediated. Eosinophils are hallmark.
39
Q

Will mucosa be blue/boggy with clear rhinorrhea in allergic rhinitis?

A
  • YES
40
Q

How do you treat allergic rhinitis?

A
  • avoidance of trigger
  • nasal decongestants and corticosteroids.
  • systemic antihistamines
41
Q

What are the most common pathogens of acute rhinosinusitis?

A
  • STREP PNEUMONIAE
  • M. catarrhalis
  • H. influenze
  • Strep pyogenes
  • Staph aureus
42
Q

How do we treat acute rhinosinusitis?

A
  • nasal irrigations
  • nasal corticosteroids
  • antibiotics (amoxicillin)
  • surgery for severe cases
43
Q

What is Pott’s Puffy tumor?

A
  • frontal sinus abscess
44
Q

What distinguishes chronic rhinosinusitis from acute?

A
  • greater than 6 weeks
45
Q

What will you see with fungal sinusitis?

A
  • fungal ball (mycetoma) usually from aspergillus (sepatated 45 degrees).
  • will be unilateral sinusitis and may lead to unilateral proptosis (bulging of the eye).
46
Q

How do you treat fungal sinusitis?

A

surgical removal of the mainstay

47
Q

What 3 things should you look for in fungal sinusitis?

A
  1. nasal polyposis
  2. allergic mucin (charcot-leyden crystals associated with eosinophilia) and looks like peanut butter.
  3. nasal mucosal inflammation
48
Q

What are the common pathogens for INVASIVE fungal sinusitis?

A
  • Mucor (90 degree broad branching hyphae)
  • Rhizopus
  • Aspergillus
49
Q

What happens with INVASIVE fungal sinusitits?

A
  • organism invades soft tissue, bone and blood (causing thrombosis and septic emboli).
  • seen in immunocompromised pts (AIDS or diabetics).
50
Q

What is classic finding for INVASIVE fungal sinusitis?

A
  • numbness of the nasal cavity and face

- necrotic black turbinates and soft palate

51
Q

How do you treat INVASIVE fungal sinusitis?

A
  • aggressive surgical debridement

- IV amphotericin

52
Q

With what areas of the nose is epistaxis associated?

A
  • WOODRUFF’S area= POSTERIOR bleeds (sphenopalatine and ascending pharyngeal vessels).
  • KIESSELBACH’S plexus (little’s area)= confluence of vessels (anterior ethmoid, greater palatine, superior labial, and sphenopalatine) located on ANTERIOR septum
53
Q

What is important to remember with epistaxis?

A
  • exam the oropharynx, because if you see blood here, you know that you haven’t controlled the nose bleed.
  • do vitals, CBC, and coagulation studies
54
Q

How do we treat epistaxis?

A
  • correct underlying issue
  • hold pressure
  • cauterization
  • packing
55
Q

Is acute pharyngitis normally due to viral causes?

A

YES

56
Q

What is the most common bacterial cause of pharyngitis?

A
  • group A strep
57
Q

What will you see with pharyngitis?

A
  • odynophagia, drooling, fever, decreased oral intake, enlarged erythematous or exudative palatine tonsils.
58
Q

How do you treat pharyngitis?

A
  • supportive care or antibiotics

- tonsillectomy for recurrent tonsillitis

59
Q

What can untreated pharyngitis cause?

A
  • pertonsillar abscess (look for bulge of soft palate)

* treat with drainage and systemic antibiotics

60
Q

Is retropharyngeal abscess more common in children or adults?

A
  • children

* hot potato voice and difficulty turning neck

61
Q

To what can retropharyngeal abscess lead?

A

mediastinitis of fascial plane from skull base to mediastinum

62
Q

What is the most common cause of epiglottitis?

A
  • H. influenzae type B in children 2-6.

* look for stridor, high fever and swollen epiglottis.

63
Q

What will you see on X-ray with epiglottitis?

A
  • thumbprint sign
64
Q

How do you treat epiglottits?

A
  • stabilize airway
  • IV antibiotics
  • inpatient monitoring
65
Q

What are the 3 types of aphthous ulcers?

A
  1. minor= less than 1 cm
  2. major (sutton’s disease= recurrent)
  3. herpetiform= numerous small ulcers lasting more than a month
66
Q

What is Bechet’s disease?

A
  • aphthous ulcers of the genitalia and upper respiratory tract
67
Q

What are the 2 common congenital neck masses?

A
  1. Thyroglossal duct cyst (TGDC)= failure of complete closure of the thyroglossal duct tract in utero. Treat with Sistrunk procedure.
  2. Branchial cleft cyst= 4 types
68
Q

What will you see on PE with thyroglossal duct cyst?

A
  • midline neck mass that moves with protrusion of the tongue. Found inferior to the hyoid and superior to the thyroid gland.
69
Q

What brachial cleft cyst is the most common?

A

second

*differentiate from thyroglossal duct cyst by non-midline mass

70
Q

What is the most common cause of lymphadenitits of the neck?

A
  • viral (EBV, CMV, HIV, adenovirus, roseola, rubella).
71
Q

What bacteria can cause infectious neck masses?

A
  • Group A strep

- Bartonella henselae (cat scratch fever)

72
Q

How do you treat infectous neck masses?

A
  • drain and antibiotics

* don’t drain if TB or Bartonella

73
Q

What is a non-malignant neoplastic neck mass?

A
  • benign salivary gland neoplasm
74
Q

What is the most common metastatic cancer of the head and neck?

A
  • squamous cell carcinoma
75
Q

What is the most common malignant salivary gland neoplasm?

A
  • mucoepidemoid carcinoma
76
Q

What should you always do on suspected neoplastic neck mass?

A
  • Fine needle aspiration bc you need to know what you’re dealing with.

Surgery 2 (13 decks)

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