ENT Flashcards
MCC of Otitis externa (2)
Pseudomonas aeruginosa
Staphylococcus aureus
Pt presents with 2 day h/o severe ear pain, itching in the external auditory canal, Otorrhea, and conductive
On physical exam the the tragus is tender to touch
and pulling up and back on the ear causes pain. TM is clear, but canal is erythematous and edematous.
Diagnosis & Treatment?
Otitis externa
Antibiotic Ear-drops: Ciprofloxacin or Gentamicin
Topical preparations with corticosteroids
A necrotizing inflammation of the external auditory canal causing osteomyelitis
MCC Pseudomonas aeruginosa s/t immunocompromise
Diagnosis → Imaging → Treatment
Malignant otitis externa (necrotizing otitis externa)
CT scan
IV ciprofloxacin +/- surgical debridement for abscess drainage
Pt presents with a 2 day history of earache and fever.
Otoscope reveals bulging tympanic membrane (TM) with
loss of light reflex and a retracted and hypomobile TM
Otitis Media
Pt presents with tender and swollen mastoid.
On exam, ear is displaced laterally and forward.
Diagnosis and next best step in management.
Mastoiditis
CT scan of the temporal bone
Feared complication of Mastoiditis
Brain Abscess
Persistent drainage from the middle ear through a perforated tympanic membrane.
Diagnosis and treatment
Chronic otitis media Topical fluoroquinolone (ciprofloxacin)
chronic mucoid or serous effusion in the tympanic cavity in the absence of infection lasting for > 3 months
Presents with painless sensation of pressure in the affected ear
Diagnosis and Treatment:
Otitis media with effusion
Tx: Tympanostomy tubes
If 4+ yo also do adenoidectomy
Best initial test: pneumatic otoscopy
Pt presents with painless otorrhea and foul-smelling discharge. Exam reveals a pearly or brown mass on TM.
Diagnosis and Treatment
Cholesteatoma
Tx: Surgery (always)
Cx: Destruction of ear ossicles
Treatment of Otosclerosis
fixation of stapes to oval window
Stapedectomy
*Cochlear implant (if bilaterally deaf)
Pt presents with recurrent epistaxis, seizures, and hemoptysis. Diagnosis
Hereditary hemorrhagic telangiectasia
Cx: High-output cardiac failure; Paradoxical emboli
Acute bilateral cervical lymphadenopathy: most commonly caused by __
viral infections of the upper respiratory tract
Subacute bilateral cervical lymphadenopathy
Predominantly caused by __ & __
EBV
CMV
Acute unilateral cervical lymphadenopathy: most commonly caused by ___
bacterial infections
(S. aureus, Strepto pyogenes)
tx: Clindamycin
An enlarged, ulcerated tonsil with ipsilateral cervical adenopathy is likely
oropharyngeal (head and neck) squamous cell carcinoma
3 causes of oropharyngeal (head and neck) squamous cell carcinoma:
Smoking
Alcohol
HPV
Retropharyngeal abscess presents with neck pain, odynophagia, and fever following penetrating trauma to the posterior pharynx. Feared complication is
acute necrotizing mediastinitis
An avulsed permanent tooth can be briefly stored in cold milk or saliva and manually reimplanted after gentle rinsing of the tooth and socket with
normal saline
An avulsed permanent tooth can be briefly stored in cold milk or saliva and manually ___ after gentle rinsing of the tooth and socket with
reimplanted
A postoperative neck hematoma should be recognized promptly and ___ to avoid potentially lethal upper airway obstruction.
drained
cricoid only if in respiratory distress
Medullary thyroid cancer arises from the ___-secreting parafollicular C cells. Serum ___ levels correlate with the risk of metastasis and recurrence, and are measured serially following surgery.
calcitonin
calcitonin
Flexible laryngoscopy shows irregular, exophytic growths in clusters on the surfaces of the vocal cords. Pathology shows no malignant features. What is the most likely cause of this patient’s laryngeal lesions?
HPV 6/11
(Laryngeal papillomas)
tx: Surgery