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PANCE Prep Pearls > ENT > Flashcards

ENT Flashcards

1
Q

Inflammation of the external auditory canal

A

Otitis Externa

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2
Q

Risk Factors for Otitis Externa

A

water immersion

local mechanical trauma

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3
Q

MC etiologies of OE

A

Pseudomonas aureginosa + Staphylococcus

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4
Q

ear pain
pruritis
tragal or ear canal pain with contact
purulent auricular discharge

A

Otitis Externa

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5
Q

Diagnosis of OE

A

clinical + otoscopy –

EAC edema with erythema, debris, or discharge

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6
Q

Management of OE

A

Avoid moisture / use drying agents
Removal debris + cerumen
Topical antibiotics

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7
Q

Topical Antibiotics for Otitis Externa

A

Ciprofloxacin-dexamethasone, ofloxacin
Alt:: Neomycin/Polymyxin-B/Hydrocortisone otic
– DO not use if TM is perforated or cannot be visualized

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8
Q

invasive infection of the external auditory canal and skull base

A

Malignant (necrotizing) otitis externa

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9
Q

Most common cause of

A

Pseudomonas aeruginosa

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10
Q

Risk Factors for malignant OE

A

immunocompromised states

Elderly diabetics

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11
Q

Severe auricular pain (esp with canal or tragal manipulation)
Otorrhea
Cranial Nerve Palsies (eg. CN VII)

A

Malignant (necrotizing) otitis externa

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12
Q

Malignant (necrotizing) otitis externa Otoscopic Finding

A

granulation tissue at the bony cartilaginous junction of the ear canal floor

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13
Q

Diagnostic Confirmation of Malignant (necrotizing) otitis externa

A

CT or MRI

Biopsy is most accurate test

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14
Q

Malignant (necrotizing) otitis externa Management

A

Admission + IV ciprofloxacin

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15
Q

Etiologies of Mastoiditis

A

complication of acute otitis media

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16
Q

Deep ear pain (worse at night), fever, postauricular tenderness, edema & erythema
Auricular protrusion

A

Mastoiditis

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17
Q

Diagnostic Study of Mastoiditis

A

CT scan w/ contrast

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18
Q

Mastoiditis management

A

IV Vancomycin + Ceftazidime || Cefepime or Piperacillin-tazobactam
+ middle ear or mastoid drainage
+/- Tympanostomy tube placement

Mastoidectomy for refractory or complications

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19
Q

recurrent or persistent infection of the middle ear plus TM perforation

A

Chronic otitis media

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20
Q

MC cause of Chronic Otitis Media

A

pseudomonas

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21
Q

Perforated TM + persistent or recurrent purulent otorrhea (often painless)
+/- conductive hearing loss

A

Chronic Otitis Media

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22
Q

Management of Chronic Otitis Media

A

Debris Removal
Ciprofloxacin or Ofloxacin
If TM rupture – avoid water, moisture, & topical aminoglycosides

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23
Q

Infection of middle ear, temporal bone, and mastoid air cells

A

Acute otitis media

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24
Q

MC bacterial causes of Acute otitis media

A

Streptococcus pneumoniae
H. influenzae
Moraxella catarrhalis
Group A Streptococcus

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25
Q

MC cause of AOM

A

viral URI -> Eustachian tube blockage

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26
Q

Fever, Otalgia, Ear Tugging, maybe pop w/ pain relief

A

Acute otitis media

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27
Q

Otoscopic Findings:
Bulging & erythematous TM w/ effusion
Decreased TM mobility

A

Acute otitis media

28
Q

Antibiotic Treatment of Acute otitis media

A

Amoxicillin

2nd: Augmentin, Cefdinir

29
Q

Middle ear fluid + no signs of acute inflammation

A

Serous otitis media with effusion

30
Q

Otoscopic Findings:

retracted or flat TM with fluid behind

A

Serous otitis media with effusion

31
Q

Management of Serous otitis media with effusion

A

Observation

+/- tympanostomy tube for drainage

32
Q

Popping of the ears + underwater feeling

A

Eustachian Tube dysfunction

33
Q

Management of ETD

A 
Autoinsufflation (swallowing, yawning, etc)
Intranasal corticosteroids (flonase)
34
Q

Damage to the tympanic membrane can occur with sudden pressure changes

A

Barotrauma

35
Q

Ear pain, fullness, & hearing loss that persists after the etiologic event.

A

Barotrauma

36
Q

Barotrauma Management

A

Avoidance is the best treatment:
• Avoidance of flying with a cold.
• Autoinsufflation (eg, swallowing, yawning, chewing gum)

37
Q

conductive hearing loss & ear fullness.
Weber lateralizes to the affected ear
Rinne: Bone > air conduction

A

cerumen impaction

38
Q

Management of TM perforation

A

Most heal spontaneously
+/- Ofloxacin
Avoid water & aminoglycosides

39
Q

abnormal keratinized collection of desquamated squamous epithelium in the middle ear that can lead to bony erosion of the mastoid

A

Choelsteatoma

40
Q 
painless otorrhea (brown or yellow discharge with a strong odor)
\+/- vertigo, tinnitus, dizziness, or cranial nerve palsies
A

Cholesteatoma

41
Q

Otoscopic Finding:
granulation tissue (cellular debris)
+/- perforated TM

Conductive Hearing Loss

A

Cholesteatoma

42
Q

Management of Cholesteatoma

A

surgical excision of the debris & cholesteatoma with reconstruction of the ossicles

43
Q

abnormal bony overgrowth of the footplate of the stapes bone leading to conductive hearing lost
Autosomal dominant disorder (+/- FamHx of conductive hearing loss)

A

Otosclerosis

44
Q

Conductive hearing loss esp at low frequencies, tinnitus

Vertigo is uncommon

A

Otosclerosis

45
Q

Most useful test for Otosclerosis

A

Tone Audiometry

46
Q

Management of Otosclerosis

A

Stapedectomy w/ prosthesis or hearing amplification (hearing aid)
If severe, cochlear implantation

47
Q

False sense of motion (or exaggerated sense of motion)

A

Vertigo

48
Q

Location of peripheral vertigo

A

Labyrinth or Vestibular nerve (CN VIII)

49
Q

Location of central vertigo

A

brainstem or cerebellar

50
Q

Etiologies of Peripheral Vertigo

A 
Benign Positional Vertigo (MC)
Meniere
Vestibular Neuritis
Labyrinthitis
Cholesteatoma
51
Q

Episodic Vertigo w/o hearing loss

A

Benign paroxysmal positional vertigo

52
Q

Episodic vertigo + hearing loss

A

Meniere disease

53
Q

Continuous vertigo w/o hearing loss

A

Vestibular neuritis

54
Q

Continuous vertigo + hearing loss

A

Labyrinthitis

55
Q

Etiologies of Central Vertigo

A 
Cerebellopontine tumors
Migraine
Cerebral Vascular Disease
Multiple Sclerosis
Vestibular Neuroma
56
Q 
Horizontal nystagmus (beating away from the affected side)
Fatigable

Sudden tinnitus & hearing loss

A

Peripheral Vertigo

57
Q

Vertical nystagmus
Nonfaigable (continuous)

Gradual onset
Positive CNS signs
Gait issues more severe

A

Central Vertigo

58
Q

Cause of N & V related to vertigo

A

Neurotransmitters GABA, Acetylcholine, histamine, dopamine, & serotonin

59
Q

How do antiemetics prevent N & V related to vertigo?

A

blocking the related neurotransmitters (GABA, acetylcholine, histamine, dopamine, & serotonin)

60
Q

What 4 classes can be used to manage N/V related to vertigo

A

Antihistamines/anticholinergics
Dopamine Blockers
Benzodiazepines
Serotonin Antagonists

61
Q

Which Antihistamines/Anticholinergics can be used for N & V related to vertigo?

A

Meclizine
Scopolamine (anticholinergic)
Dimenhydrinate
Diphenhydramine

62
Q

MOA of Antihsitamiens/anticholinergics [N & V w/ vertigo]

A

acts on the brain’s control center for N, V, & D

63
Q

What are the 1st line meds for Vertigo (N/V) & motion sickness

A 
Antihistamines/Anticholinergics -- 
Meclizine
Scopolamine (anticholinergic)
Dimenhydrinate
Diphenhydramine
64
Q

Side Effects of Antihistamines/Anticholinergics when related to vertigo (N/V)

A

Anticholinergic Effects –

  • blurred vision (dilated pupils)
  • urinary retention
  • dry mouth
  • constipation
  • dry skin
  • flushing
  • tachycardia
  • fever
  • delirium
65
Q

What are the dopamine blockers that can be used with N/V in vertigo?

A

Prochlorperazine
Promethazine
Metoclopramide

66
Q

What is the MOA of dopamine blockers?
Prochlorperazine
Promethazine
Metoclopramide

A

blocks CNS dopamine receptors (D1, D2) in the brain’s vomiting center

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