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Clerkship (CC3) > ENT > Flashcards

ENT Flashcards

1
Q

<p>What is the differential for watery rhinorrhea (6)</p>

A

<p>1) allergic rhinitis
<br></br>2) medication side-effect (rebound)
<br></br>3) vasomotor rhinitis
<br></br>4) infectious rhinitis
<br></br>5) sinusitis
<br></br>6) structural abnormality</p>

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2
Q

<p>What is the non-phramacological management of allergic rhinitis</p>

A

<p>Avoid allergen, irrigate the nose</p>

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3
Q

<p>What is the appropriate physical exam for rhinitis?</p>

A

<p>Vitals
<br></br>Inspection: external appearance of eyes, nose, and external auditory canal, otoscope, nasal speculum CN exam, oral cavity</p>

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4
Q

<p>What investigations are needed to diagnose allergic rhinitis?</p>

A

<p>None; it's a clinical diagnosis.</p>

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5
Q

<p>What is the medical management of allergic rhinitis?</p>

A

<p>Antihistamines, decongestants, steroids (1st line), allergen injections, anticholinergics (ipratropium)</p>

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6
Q

<p>How is sinusitis classified?</p>

A

<p>Acute <4 wks
<br></br>Subacute 4wks-3mos
<br></br>Chronic > 3mos</p>

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7
Q

<p>What are the most common symptoms of acute sinusitis? (4)</p>

A

<p>Purulent secretions, facial pain, nocturnal cough, dental pain.</p>

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8
Q

<p>What are the most common pathogens that cause bacterial sinusitis?</p>

A

<p>Strep pneumo and Haemophilus influenza?</p>

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9
Q

<p>What is the nonpharmacological management of acute sinusitis?</p>

A

<p>Observation, nasal saline spay</p>

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10
Q

What is the pharmacological management of acute sinusitis?

A

Analgesic for symptomatic pain relief,
Amox 500mg TID x10-14d (if symptoms severe or worsening)h
Topical glucocorticoids

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11
Q

<p>What are 6 important questions to ask on Hx for hearing loss?</p>

A

<p>When did hearing loss start?
<br></br>Hx of noise exposure or ear trauma?
<br></br>What is the defect?
<br></br>Progressive? Tinnitus? FH?
<br></br>Constitutional or CN symptoms
<br></br>Otalgia, otorrhea or infection?</p>

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12
Q

<p>How do you interpret a Weber test?</p>

A

<p>Normal is midline. A sensorineural loss lateralizes to the opposite side. A conductive loss to the same side.</p>

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13
Q

<p>How do you interpret the Rinne test?</p>

A

<p>Air conduction > bone conduction is normal. Bone > air is conductive loss</p>

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14
Q

<p>What are some common causes of conductive hearing loss?</p>

A

<p>External: otitis externa, impacted wax, foreign body,
<br></br>Middle ear: otitis media w or w/o infusion, perforation or otosclerosis</p>

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15
Q

<p>What questions are important to ask on history when a patient complains of vertigo?</p>

A

<p>When does it happen, OPQRST
<br></br>What triggers episodes
<br></br>N/V. Hx of infection or trauma. MEDS. Aural fullness, or oto symptoms. Dysphagia, odynophagia, voice changes.</p>

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16
Q

<p>What physical exam is indicated for vertigo?</p>

A

<p>Vitals, cerebellar exam, CN, ophtho, head/neck and dix-hallpike</p>

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17
Q

<p>Describe how to do the dix-hallpike maneuver</p>

A

<p>Start patient sitting, get them to lie down quickly and have them turn their head to the side (e.g. follow finger). Watch for nystagmus. Return to sitting 30s, then try other side.</p>

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18
Q

<p>How does the Dix-Hallpike differentiate between peripheral and central vertigo?</p>

A

<p>Latent period: peripheral YES (2-20s) central NO
<br></br>Duration: peripheral < 1min else central
<br></br>Fatiguability: peripheral YES central no
<br></br>Direction: peripheral usually unidirectional horizontal/rotary</p>

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19
Q

<p>What is the DDx of "uncomplicated" vertigo (6)?</p>

A

<p>BPPV, postural hypotension, meniere's, chronic unilateral vestibular hypofunction, central positional vertigo, migrainous vertigo.</p>

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20
Q

<p>What are some causes of sensorineural hearing loss?</p>

A

<p>Congenital vs acquired
<br></br>Acquired can be presbycusis, noise-induced Meniere's, diabetes & HTN, ototoxic drug exposure, trauma, infectious (vi, acoustic neuroma....</p>

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21
Q

<p>Which frequencies tend to be impacted first by presbycusis?</p>

A

<p>Higher frequency sounds.</p>

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22
Q

<p>What is the first line treatment for presbycusis? What's important to tell patients about their limitations?</p>

A

<p>Hearing aids—but they only make sounds louder, but cannot make them clearer</p>

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23
Q

<p>How do you interpret an audiogram?</p>

A

<p>Threshold intensity <20db is normal, >40db tends to be the significant hearing los (Red for Right, Blue for Left). Threshold is how loud a sound has to be before perceiving the sound</p>

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24
Q

<p>What is the first step to manage epistaxis?</p>

A

<p>Don PPE, make sure ABCs are stable, establish IV access. if needed</p>

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25
Q

<p>What is conservative management of epistaxis? What must you do before proceeding with further measures?</p>

A

<p>Squeeze nasal cartilage, bend at waist, optional oxymetazoline. Try to visualize the source of the bleed.</p>

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26
Q

<p>What can you do with patients that continue to bleed despite conservative measures?</p>

A

<p>Cauterize (e.g. silver nitrate) if source of bleeding visible.<br></br>
Pack the nose (e.g. tampon, gauze + vaseline).</p>

<p>If bleeding continues, consult ENT for posterior packing or surgical management.</p>

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27
Q

<p>What is the area from which 90% of epistaxis originates from?</p>

A

<p>Kiesselbach's plexus</p>

<p>(Little's area)</p>

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28
Q

<p>When cauteri</p>

A
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29
Q

<p>What are some risk factors for hearing loss in infants?</p>

A

<p>Cleft palate, ECMO, hyperbilirubinemia requiring exchange, TORCH infections</p>

<p>Atresia or microtia</p>

<p>Meningitis</p>

<p>Syndromes</p>

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30
Q

<p>What should you do if you have a baby that has a refer result from the infant hearing program?</p>

A

<p>Nothing—there should be an automated referral to diagnostic audiology.</p>

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31
Q

<p>Whar are key points to get on hx from the patient who presents with neck mass?</p>

A

<p>When did it start? Progressive or fluctuant size?</p>

<p>Otalgia / obstruction / hearing changes?</p>

<p>Dysphagia / odynophagia, voice changes?</p>

<p>URTI / TB / or other infectious symptoms?</p>

<p>Constitutional symptoms?</p>

<p>Cigarettes / alcohol</p>

<p>Radiation exposure?</p>

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32
Q

<p>What physical exam is appropriate for the patient who presents with neck mass?</p>

A

<p>Vitals</p>

<p>Tympanic membrane</p>

<p>Nasal mucosa, oral cavity</p>

<p>Thyroid</p>

<p>Lymph nodes</p>

<p>Cranial nerve exam</p>

33
Q

<p>What is the DDx for a solitary neck mass (7)</p>

A

<p>Neoplasm: Nasopharyngeal carcinoma, lymphoma</p>

<p>Inflammatory lymphadenopathy, TB</p>

<p>Benign: Thyroglossal duct cyst, Angiofibroma</p>

<p>Salivary gland tumor</p>

34
Q

<p>What investigations are indicated for a neck mass?</p>

A

<p>Imaging: Start with U/S or contrast CT of neck, FNAB</p>

<p>Labs: CBC, LFTs, Thyroid, EBV</p>

35
Q

<p>How do you diagnose acute otitis media? What is the<em>essential</em>feature that must be present?</p>

A

<p>Any (1) of the following:</p>

<p>Moderate-severe bulging of TM</p>

<p>New onset otorrhea,<em>not</em>otitis externa (i.e. due to ruptured TM)</p>

<p>Mild TM bulging + either recent (<48-hr) ear pain OR intense erythema.</p>

<p>Must have a middle ear effusion.</p>

36
Q

<p>What is the first line management for nasopharyngeal carcinoma?</p>

A

<p>Radiation therapy</p>

37
Q

<p>What predisposes children to AOM?</p>

A

<p>Daycare, tobacco smoke, bottle propping, craniofacial abnormalities, immunodeficiency, FH, First Nations / inuit ancestry</p>

38
Q

<p>What are the risk factors for nasopharyngeal cancer?</p>

A

<p>Southern Chinese descent, male, salt fish diet, EBV, FH</p>

39
Q

<p>What are some intratemporal complications of otitis media?</p>

A

<p>TM perforation or sclerosis, cholesteatoma, hearing loss, mastoiditis </p>

40
Q

<p>What are the most common bacterial causes of AOM?</p>

A

<p>Strep pneumo, H flu, Moraxella Catarrhalis</p>

41
Q

<p>What are the criteria for observation in children with AOM?</p>

A

<p>< 6 mos treat with Abx</p>

<p>6mos-2yrs if unilateral but not severe (i.e. no otalgia >48hrs T>39C)</p>

<p>2 years old can do it if it's not bilateral and no otorrhea</p>

<p>No complications/ immunodeficiency / HN issues</p>

42
Q

<p>What is the treatment for AOM?</p>

A

<p>Treat pain / fever with acetaminophen</p>

<p>Do amox 40mg/kg/day 1st line</p>

43
Q

<p>What are the best ways of preventing AOM?</p>

A

<p>Exclusive breastfeeding for > 6 mos</p>

<p>Avoiding tobacco smoke</p>

<p>Influenza & pneumococcal vaccine</p>

44
Q

<p>What is the definition of recurrent AOM? What do you do for these patients?</p>

A

<p>3 ep < 6 mos</p>

<p>4 in a year with 1 in last 6 mos</p>

<p>Tympanostomy tubes</p>

45
Q

<p>What is the most common cause of hearing loss after AOM?</p>

A

<p>Effusion post-AOM</p>

46
Q

<p>What is the diagnosis? What other symptoms do the patients complain about?</p>

A

<p>Otitis media with effusion</p>

<p>Hearing loss</p>

47
Q

<p>How do you manage otitis media with effusion?</p>

A

<p>Observe up to 3 months,</p>

<p>Audiogram if HL persists</p>

<p>Can offer tubes if effusion persists with hearing loss > 3 mos bilateral or chronic unilateral HL >3 mos with behavioral issues or at-risk.</p>

48
Q

<p>What are the structures on either side? What's the structure under the pointer?</p>

A

<p>Tonsils, uvula</p>

49
Q

<p>What are some features of OSA in children (7)?</p>

A

<p>Hyperactivity</p>

<p>Snoring</p>

<p>Restlessness</p>

<p>Enuresis</p>

<p>Daytime sleepiness</p>

<p>Poor school performance</p>

<p>Failure to thrive</p>

50
Q

<p>How do we define an apneic episode? How many are normal in kids? Before tonsillectomy how many apneic episodes are indicated?</p>

A

<p>pause in breathing > 2 breaths.</p>

<p>1 per hour is normal</p>

<p>5+ is indicated for surgery (moderate OSA, 10+ is severe)</p>

51
Q

<p>What are the absolute indications for tonsillectomy?</p>

A

<p>OSA with hypopnea >5/hr + large tonsils</p>

<p>Cor pulmonale, suspecteve malignancy, severe dysphagia, hemorrhagic tonsilitis</p>

52
Q

<p>What are the relative indications for tonsillectomy?</p>

A

<p>Recurrent tonsillitis, Hypertrophy, Complications of tonsillitis, Tonsilliths.</p>

53
Q

<p>What PEx is indicated for suspected AOM (6)?</p>

A

<p>External auditory canal, inspection</p>

<p>Tympanic membrane</p>

<p>Pneumatic otoscopy</p>

<p>Nasal mucosa</p>

<p>Oropharynx</p>

<p>Lymph nodes</p>

54
Q

<p>What is the likely diagnosis in this 2 month old with inspiratory stridor worse when supine?</p>

A

<p>Laryngomalacia</p>

55
Q

<p>What are the key features which cause inspiratory stridor and progression of disease?</p>

A

<p>Short aryepiglottic folds lead to prolapse of the epiglottis and blockage of larynx -> negative pressure in esophagus and then causes acid + irritation of the arytenoids.</p>

56
Q

<p>How do you treat laryngomalacia?</p>

A

<p>PPI first attempt (need 1 hour before and after eating)</p>

<p>Surgical management (supraglottoplasty) if they fail PPI therapy and continue to have failure to thrive.</p>

57
Q

<p>Which ear is this? Is it normal or not?</p>

A

<p>R ear (malleus to the right, normal)</p>

58
Q

<p>What is the diagnosis?</p>

A

<p>Acute otitis media</p>

59
Q

<p>What is the diagnosis?</p>

A

<p>Cholesteotoma</p>

60
Q

<p>What is the diagnosis?</p>

A

<p>Otitis media with effusion</p>

<p>(thick effusion</p>

61
Q

<p>What do you see?</p>

A

<p>Haemotympanum</p>

62
Q

<p>Which window does the stapes sit on?</p>

A

<p>Oval window</p>

63
Q

<p>What structure is under the pointer?</p>

A

<p>Eustachian tube</p>

64
Q

<p>What is the diagnosis</p>

A

<p>Perforation (likely traumatic)</p>

65
Q

<p>What are the 5 things you always want to ask when the patient presents with ear complaint?</p>

A

<p>Hearing loss, tinnitus, vertigo, pain and discharge?</p>

66
Q

<p>What are the 5 Ts of referred ear pain?</p>

A

<p>Teeth</p>

<p>Tonsils</p>

<p>TMJ</p>

<p>Thyroiditis</p>

<p>Ticker (angina)</p>

67
Q

<p>What is the diagnosis?</p>

A

<p>Otitis externa</p>

68
Q

<p>What is the diagnosis?</p>

A

<p>Cerumen impaction</p>

69
Q

<p>What is the diagnosis?</p>

A

<p>This is a normal ear after water exposure</p>

70
Q

<p>What bugs cause otitis externa?</p>

A

<p>Staph aureus</p>

<p>Pseudomonas</p>

71
Q

<p>What are 1 and 2?</p>

A

<p>1) chorda tympani</p>

<p>2) round window</p>

72
Q

<p>What is the diagnosis?</p>

A

<p>OME</p>

73
Q

<p>What is the diagnosis?</p>

A

<p>Retraction of TM</p>

74
Q

<p>What is the diagnosis? Where does it start from?</p>

A

<p>Acquired Cholesteatoma; typically posterior/superior quadrant</p>

75
Q

<p>What is the diagnosis? How do you differentiate it from cholesteatoma?</p>

A

<p>Tympanosclerosis</p>

<p>no foul smell, discharge or hearing loss</p>

76
Q

<p>What is the differential diagnosis in this afebrile child with a palpable cervical LN on the right side of the neck and difficulty speaking? (6)</p>

A

<ol>
<li>Peritonsillar abcess</li>
<li>peritonsillar cellulitis</li>
<li>mononucleosis</li>
<li>Viral pharyngitis</li>
<li>Streptococcal tonsillitis</li>
<li>Neoplasm</li>
</ol>

77
Q

<p>How do you manage peritonsillar abcess?</p>

A

<p>Needle aspiration, I/D, Tonsillectomy, ABx and/or supportive care</p>

78
Q

What investigations are needed to diagnose acute sinusitis?

A

None, bacterial culture & CT/ X-ray not indicated unless complicated.

Clerkship (CC3) (12 decks)

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