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PHASE II > ENT > Flashcards

ENT Flashcards

1
Q

What are the ranges of hearing loss from NML to Profound

A

Decibel ranges are from 0-80dB
And increase in 20 dB intervals

NML; 0-20 (whisper)
Mild: 20-40
ModL 40-60 (NML spoken voice)
Severe 60-80
And Profound is hearing loss greater than 80dB (shouting)

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2
Q

What are the 4 causes of Conductive Hearing Loss

A

Four mechanisms each result in impairment of the passage of sound vibrations to the inner ear:

(1) obstruction
(eg, cerumen impaction)

(2) mass loading
(eg, middle ear effusion)

(3) stiffness
(eg, otosclerosis)

(4) discontinuity
(eg, ossicular disruption)

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3
Q

What are the most common causes of conductive hearing loss in adults

A

Conductive losses in adults are most commonly due to cerumen impaction or transient eustachian tube dysfunction from upper respiratory tract infection.

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4
Q

What is the cause of sensory hearing loss

A

Sensory hearing loss results from deterioration of the cochlea, usually due to loss of hair cells from the organ of Corti

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5
Q

What is the most common form of sensory hearing loss

A

The most common form is a gradually progressive, predominantly high-frequency loss with advancing age (presbyacusis)

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6
Q

Is senosry hearing loss correctable?
Is conduction hearing loss correctable?

A

Sensory hearing loss is usually not correctable with medical or surgical therapy but often may be prevented or stabilized.

An exception is a sudden sensory hearing loss, which may respond to corticosteroids if delivered within several weeks of onset.

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7
Q

What is the exception for treating sensory hearing loss that occurs suddenly

A

Usually senosry hearing loss is not correctable unless it occurs sunddely in which case it can be treated with corticosteroids within the first several weeks of onset

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8
Q

What are the 4 areas that can contribute to neural hearing loss

A

Neural hearing loss lesions involve:
-eighth cranial nerve
-auditory nuclei
-ascending tracts
-auditory cortex

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9
Q

What are the common causes of neural hearing loss

A

Causes include acoustic neuroma, multiple sclerosis, and auditory neuropathy.

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10
Q

Weber lateralized to the normal ear and AC>BC on Rinne

What kind of hearing loss

A

Sensorineural

AC>BC= Normal
And AC latz to the NML ear

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11
Q

Weber laterlizes to the Affected Ear and BC>AC on Rinne

What kind of hearing loss

A

This is Conductive

Sound is not getting through the ear canal

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12
Q

How does conductive hearing loss appear on audiology

A

Pure-tone thresholds in decibels (dB) are obtained over the range of 250–8000 Hz for both air and bone conduction.

Conductive losses create a gap between the air and bone thresholds

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13
Q

How does Sensorineural Hearing loss show on Audiology

A

Pure-tone thresholds in decibels (dB) are obtained over the range of 250–8000 Hz for both air and bone conduction.

in sensorineural losses, both air and bone thresholds are equally diminished.

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14
Q

What are the thresholds for Audiology dB

A

Formal audiometric studies are performed in a soundproofed room.

Pure-tone thresholds in decibels (dB) are obtained over the range of 250–8000 Hz for both air and bone conduction

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15
Q

What does speech discrimination measure

A

Speech discrimination measures the clarity of hearing, reported as percentage correct
(90–100% is normal).

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16
Q

What is the most specific and sensitive test for detecting central lesions that contribute to hearing loss

A

Auditory brainstem-evoked responses may determine whether the lesion is sensory (cochlea) or neural (central).

However, MRI scanning is more sensitive and specific in detecting central lesions.

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17
Q

Every patient who complains of a hearing loss should be referred for….

A

audiologic evaluation unless the cause is easily remediable
(eg, cerumen impaction, otitis media)

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18
Q

What is the Treatment for pts with idiopathic sudden onset sensorineural hearing loss

A

Immediate audiometric referral is indicated for patients with idiopathic sudden sensorineural hearing loss because it requires treatment (corticosteroids) within a limited several-week time period

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19
Q

When is routine audiologic screening recommended

A

Routine audiologic screening is recommended for adults with prior exposure to potentially injurious noise levels or in adults at age 65, and every few years thereafter.

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20
Q

What is the Hearing aid that is best for conductive hearing loss or those with unilateral sensorineural hearing loss

A

For patients with conductive loss or unilateral profound sensorineural loss, bone-conducting hearing aids directly stimulate the ipsilateral cochlea (for conductive losses) or contralateral ear (profound unilateral sensorineural loss).

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21
Q

What pts benefit from cochlear implants for hearing loss

A

In most adults with severe to profound sensory hearing loss, the cochlear implant—an electronic device that is surgically implanted into the cochlea to stimulate the auditory nerve—offers socially beneficial auditory rehabilitation

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22
Q

What seperates polychondritis and perichondritits

A

Polychondritis and perichondritis may be differentiated from cellulitis by sparing of involvement of the lobule, which does not contain cartilage.

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23
Q

What is the treatment for traumatic auricular hematoma

A

Traumatic auricular hematoma must be drained to prevent significant cosmetic deformity (cauliflower ear) or canal blockage resulting from dissolution of supporting cartilage

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24
Q

Define Relapsing polychondritis

A

Relapsing polychondritis is characterized by recurrent, frequently bilateral, painful episodes of auricular erythema and edema and sometimes progressive involvement of the cartilaginous tracheobronchial tree.

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25
Q

What is the treatment that may forestall cartilage dissolution in pts with relapsing polychondritis

A

Treatment with corticosteroids may help forestall cartilage dissolution.

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26
Q

Why must ear irrigation be done with water at body temp

A

Irrigation is performed with water at body temperature to avoid a vestibular caloric response.
(Vertigo)

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27
Q

Where is the stream of irrigation directed in the ear to remove cerumen impaction

A

The stream should be directed at the posterior ear canal wall adjacent to the cerumen plug.

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28
Q

Can you irrigate a cerum impaction if there is evidence of tympanic membrane?

A

NO!

Irrigation should be performed only when the tympanic membrane is known to be intact.

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29
Q

What agent can be used to dry the ear canal after cerumen dis impaction

A

Alcohol

(To reduce the likely hood of external otitis)

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30
Q

Tympanic membrane perforation may lead to what complication

A

Cholesteatoma

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31
Q

What is the most common location for a tympanic membrane rupture

A

At the Pars Tensa

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32
Q

A pt presents with ear pain with sudden pain relief and bloody otorrhea, tinnitus and vertigo

Think

A

Tympanic Rupture

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33
Q

What type of hearing loss is associated with tympanic rupture

A

Conductive hearing loss

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34
Q

What should be avoided in pts with tympanic rupture

A

Water immersion and topical Aminoglycosides (gentamycin)

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35
Q

What instrument is used to remove firm objects lodged in the ear

A

Firm materials may be removed with a loop or a hook, taking care not to displace the object medially toward the tympanic membrane; microscopic guidance is helpful

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36
Q

Should organic material be removed with aqueous irrigation

A

Aqueous irrigation should not be performed for organic foreign bodies (eg, beans, insects), because water may cause them to swell

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37
Q

What is the best way to remove insects for the ear canal

A

Living insects are best immobilized before removal by filling the ear canal with lidocaine.

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38
Q

What is a possible complication of otitis externa in DM or immunocomprimised pts

A

In diabetic or immunocompromised patients, osteomyelitis of the skull base (“malignant external otitis”) may occur.

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39
Q

A pt presents with Ear pain (otalgia) pruritus, and purulent discharge.

With a recent history of waters exposure or mechanical trauma

Physical exam shows pain on traction of the ear canal or tragus

Think

A

Otitis externa

40
Q

What is the most common cause of otitis externa

A

External otitis is usually caused by gram-negative rods (eg, Pseudomonas, Proteus) or fungi (eg, Aspergillus), which grow in the presence of excessive moisture.

41
Q

Who is most at risk of malignant otitis externa

A

diabetic or immunocompromised patients, with persistent external otitis may evolve into osteomyelitis of the skull base (so-called malignant external otitis)

42
Q

What is the general spread of malignant external otitis

A

Usually caused by Pseudomonas aeruginosa, osteomyelitis begins in the floor of the ear canal and may extend into the middle fossa floor, the clivus, and even the contralateral skull base.

43
Q

What part of the tympanic membrane is made of ear canal skin

A

The lateral part

Which is why in otitis externa the lateral part of the tympanic membrane may appear erythematous

However, in contrast to acute otitis media, it moves normally with pneumatic otoscopy

44
Q

What are the findings in Malignant external otitis

A

Malignant external otitis typically presents with:
- persistent foul aural discharge
-granulations in the ear canal
- deep otalgia

advanced cases: progressive palsies of cranial nerves VI, VII, IX, X, XI, or XII.

45
Q

What is the confirmatory study for malignant external otitis

A

Diagnosis is confirmed by the demonstration of osseous erosion on CT scanning.

46
Q

What mixture of agents can be used to dry otitis externa

A

In cases of moisture in the ear (eg, swimmer’s ear), acidification with a drying agent (ie, a 50/50 mixture of isopropyl alcohol/white vinegar) is often helpful.

47
Q

What are the ABX used to treated infected otitis externa

A

When infected, an otic antibiotic solution or suspension of an aminoglycoside (eg, neomycin/polymyxin B) or fluoroquinolone (eg, ciprofloxacin), with or without a corticosteroid (eg, hydrocortisone), is usually effective

48
Q

In a pt with otitis externa that has developed cellulitis

What is the Tx approach

A

In recalcitrant cases—particularly when cellulitis of the periauricular tissue has developed—oral fluoroquinolones
(eg, ciprofloxacin, 500 mg twice daily for 1 week) are used because of their effectiveness against Pseudomona

49
Q

When would you refer a case of otitis externa for specialty evaluation

A

Any case of persistent otitis externa in an immunocompromised or diabetic individual must be referred for specialty evaluation.

50
Q

What is the treatment approach to malignant external otitis

A

Treatment of “malignant external otitis” requires prolonged antipseudomonal antibiotic administration, often for several months.

Although intravenous therapy is often required initially (eg, ciprofloxacin 200–400 mg every 12 hours), selected patients may be graduated to oral ciprofloxacin (500–1000 mg twice daily)

51
Q

How long should ABX be taken for malignant otitis externa

A

To avoid relapse, antibiotic therapy should be continued, even in the asymptomatic patient, until gallium scanning indicates marked reduction or resolution of the inflammation.

52
Q

What are the most common cause of pruritus of the ear

A

While it may be associated with external otitis or with seborrheic dermatitis or psoriasis, most cases are self-induced from excoriation or overly zealous ear cleaning

53
Q

What is the tx for dry skin pruritus of the ear canal

A

Patients with excessively dry canal skin may benefit from application of mineral oil, which helps counteract dryness and repel moisture.

54
Q

What is the treatment for ear pruritus that is inflammatory

A

When an inflammatory component is present, topical application of a corticosteroid (eg, 0.1% triamcinolone) may be beneficial.

55
Q

What is surfers ear

A

Boney overgrowths of the ear due to repeated cold water exposure

56
Q

Are exostoses or osteomas clinically signifigant?

A

Clinically, they present as skin-covered bony mounds in the medial ear canal obscuring the tympanic membrane to a variable degree.

Solitary osteomas are of no significance as long as they do not cause obstruction or infection.

57
Q

What is the most common neoplams of the ear canal

A

The most common neoplasm of the ear canal is squamous cell carcinoma

58
Q

What should be suspected if an apparent otitis externa does not resolve on therapy

A

When an apparent otitis externa does not resolve on therapy, a malignancy should be suspected and biopsy performed

59
Q

What is the mortality rate of Squamous Cell Carcinoma of the EAR

A

This disease carries a very high 5-year mortality rate because the tumor tends to invade the lymphatics of the cranial base and must be treated with wide surgical resection and radiation therapy.

60
Q

What are the 5 Ws of Post operative fevers

A

five Ws of postop fever
—wind (atelectasis)
— water (UTI)
—walking (DVT)
—wound (SSI)
—wonder drug/ Womb
(Drugs can cause fever)

61
Q

Which works better to prevent atelectasis

Coughing or deep inspiration?

A

Deep Inspiration

62
Q

What is the best way to prevent post op DVT

A

Getting the patient up and walking on POD 1 is the best way to prevent this complication.

If unable to ambulate pts should be placed on low dose heparin or venous compression devices

63
Q

Define Choanal Atresia

A

Choanal atresia is a congenital disorder in which the nasal choana is occluded by soft tissue, bone, or a combination of both.

64
Q

A newborn that presents with unilateral mucopurulent discharge should have a high index of suspicion for what airway malformation

A

Choral atresia

If the condition present bilaterally then the newborn will be unable to breathe

65
Q

What is the temporary adjunct for neonates that present with Choanal atresia

A

Montgomery nipple

66
Q

Treatment for Ludwigs angina

A

Treatment requires incision and drainage of the abscess.

67
Q

Most common cause of Ludwigs Angina

A

The most common cause of
this abscess is infection in the teeth.

68
Q

What causes Ludwigs angina puss to flow into the submandibular space and parapharyngeal space

A

The mylohyoid line on the inner
aspect of the body of the mandible
descends on a slant, so that the tips
of the roots of the second and third
molars are behind and below this
line.

Therefore, if these teeth are
abscessed, the pus will go into the
submandibular space and may
spread to the parapharyngeal space.

69
Q

What is the first line ABX for Ludwig’s angina

A

Ampicillin/ Sulbactam (IV) QID

Or Ceftriaxone and metronidazole (IV)

PCN ALRGY: Clindamycin and Levofloxacin

70
Q

What would cause a tooth abscess and Ludwig’s angina to flow into the sublingual space

A

If the tooth roots are above the mylohyoid line, as they are from the first molar forward, the infection will enter the sublingual space above and infront of the mylohyoid

71
Q

Should intubation be attempted in pts with Ludwig’s angina

A

The firm tongue swelling prevents stan- dard laryngeal exposure with a laryngoscope blade, so intubation should not be attempted.

72
Q

Why should Ludwigs angina pts always get advanced surgical airways

A

Even if there is no airway obstruction on presentation, it may develop after you operate and drain the pus. This results from postoperative swelling, which can be worse than the swelling on initial presentation.

73
Q

What are the two causes of Angioneurotic Edema

A

either familial or caused by a functional or quanti- tative deficiency of C1-esterase inhibitor

74
Q

What are the common Rx for Acute Supraglottic swelling
( Angioneurotic Edema)

A

Common Rx are IV steroids, H1 and H2 blockers

75
Q

What is the vax that prevents Epiglottitis

A

H. Influenza Vax

76
Q

Define: This condition is a collection of puru- lence in the space between the tonsil and the pharyngeal constrictor.

A

Peritonsillar abscess

77
Q

What are the hallmark signs of peritonsillar abscess

A

The hallmark signs of peritonsillar abscess are fullness of the anterior tonsillar pillar, uvular deviation AWAY from the side of the abscess, a “hot potato” voice, and,
in some patients, trismus
(difficulty opening the jaws).

78
Q

What is the Tx for peritonsillar abscess

A

Treatment includes drainage or aspiration, adequate pain control, and antibi- otics.

Tonsillectomy may be indi- cated, depending on the patient’s history.

79
Q

What is the MGMT for patients with foreign body airway obstruction

A

Foreign bodies in the pharynx or laryngeal inlet can often be extracted by Magill forceps after laryngeal exposure with a standard laryngoscope.

The patient will usually vomit, so suction is mandatory.

80
Q

What is the procedure to remove bronchial foreign bodies

A

Bronchial foreign bodies will require operative bronchoscopy for removal.

Occasionally, a tracheotomy will be required, such as for a patient who has aspirated a partial denture with imbedded hooks

81
Q

What is the typical presentation for pts with bronchial foreign bodies

A

Occasionally, these patients present as airway emergen- cies, although they more typically present with unexplained cough or pneumonia.

82
Q

What is the easiest way to evaluate a ball-valve obstruction of the airway

A

Inspiration-expiration films

83
Q

What is the typical pt that presents with fungal infections (Mucormycosis)

A

Typically, mucormycosis appears in patients receiving bone marrow transplantation or chemotherapy.

classically those with diabetes with poor glucose regulation who became acidotic

84
Q

What is the acidic cycle of mucormycosis

A

1st a DM pt has poor glycemic control and becomes acidotic allowing the fungus to start to grow

The fungus leads to growths in the blood vessels causing thrombosis and distal ischemia and ultimately tissue necrosis.

This necrosis leads to further acidic environment with in turn feeds the fungus.

85
Q

A pt presents with facial pain and black turbinates

Think

A

Mucromycosis

Confirm this with biopsy showing acutely branching nonseptate hyphae

86
Q

Where does mucormycosis start? Where does it spread

A

Usually the infection starts in the sinuses, but rapidly spreads to the nose, eye, and palate, and up the optic nerve to the brain.

87
Q

What is the Rx of choice for Mucormycosis

A

Amphotericin B is the drug of choice

88
Q

What is the MGMT for a pt with mucormycosis

A

Treatment is immediate correction of the acidosis and metabolic stabili- zation, to the point where general anesthesia will be safely tolerated (usually for patients in diabetic ketoacidosis who need several hours
for rehydration, etc.).

Then, wide debridement is necessary, usually consisting of a medial maxillectomy but often extending to a radical maxillectomy and orbital exenteration (removal of the eye and part of the hard palate) or even beyond.

89
Q

How do you safely administer Amphotericin B to a pt with compounding renal failure

For Mucormycosis

A

Newer lyso- somal forms of amphotericin B have been shown to salvage these patients by permitting higher doses of drug

90
Q

Where is the most common source of bleeding for epistxsis

A

The most common bleed is from the anterior part of the septum

Kisselbacks plexsus

91
Q

What is the immediate treatment for epistaxis

A

nose- bleeds should be treated with oxymetazoline or phenylephrine nasal spray and digital pressure for 5–10 minutes.

92
Q

What is often the warning sign that a pt with Epistaxis is using cocaine

A

A perforated nasal septum can be a warning sign

93
Q

Bleeding from the back of the nose in an adolescent male is considered to be…

A

juvenile nasopharyngeal angiofibroma until proven otherwise

94
Q

What is the diastolic BP goal for pts with recurrent nose bleeds

A

Less than 90 mmHG

95
Q

When should you admit a pt with epistaxis

A

if bilateral nasal packing is used or a posterior pack is placed, patients will need to be admitted to the hospital and carefully watched, because they can suffer from hypo- ventilation and oxygen desaturation.

96
Q

Rx of choice in malignant otitis externa

A

Quinolones are the drugs of choice because they are active against Pseudomonas organisms.

97
Q

What is the time frame to Dx Sudden sensorineural hearing loss (SSHL)

A

Sudden sensorineural hearing loss (SSHL) is an idiopathic, unilateral, sensorineural hearing loss with onset over a period of less than 72 hours.

PHASE II (3 decks)

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