ENT Flashcards
Most common cause of conductive hearing loss
Effusion
Keratinization of the epithelial cells in the middle ear
Cystic-like mass
Result of chronic suppurative otitis media or chronic Eustachian tube dysfunction
Develop behind mid anterior quadrant of TM
Dissolve bone and reach CNS
Cholesteatoma
Most common cause of sensorineural hearing loss
Congenital CMV
Sudden onset of bilateral sensorineural hearing loss
Viral labyrinthitis
Most common cause of acquired sensorineural hearing loss in childhood
Bacterial meningitis
Most common cause of acquired sensorineural hearing loss on childhood
Bacterial meningitis
Test the vestibulocochlear nerve’s response to sound
Auditory brainstorm response (ABR)
Test the hair cell function
Measures sounds that are made by the cochlea
Otoacoustic emissions (OAE)
Middle ear function
Response to change in air pressure
Tympanometry
Type A tympanogram
Normal
Type As tympanogram
Shallow amplitude
TM scarring
Otisclerosis
Ossicular fixation
Type Ad tympanogram
Higher amplitude
Ossicular disarticulation
Type B tympanogram
No peak, Flat line, Low amplitude
Stiff membrane
Middle ear fluid
Obstructed tympanostomy tube
High amplitude - continuity between middle and outer ear with perforated TM
Absence of pressure or mobility
Type C tympanogram
Left shifted peaked graph
Eustachian tube dysfunction
Conductive hearing loss is likely
Diagnostic criteria for acute otitis media
Best diagnostic test
Recent abrupt onset (< 48 hr)
Bulging TM with effusion
Erythema of TM
Pneumatic otoscopy
Most common bacterial for acute otitis media
Strep pneumo
H flu
Moraxella catarrhalis
GAS
Most common bacteria for acute otitis media
Purulent ear drainage for > 6 wk
Most common cause
Treatment
Chronic suppurative otitis media
Pseudomonas
Topical/otic ofloxacin
Treatment of choice for recurrent otitis media
Tympanostomy tubes
Antibiotic choose for otitis media
1) high dose Amoxicillin (90mg/kg/day)
2) Augmentin
3) ceftriaxone IM x 3 days
Pain with pinna manipulation
Usual cause
Otitis externa
Pseudomonas
Most common suppurative complication of acute otitis media
Postauricular swelling
Tender masotoid
Outwardly displaced pinna
Diagnostic test
Mastoiditis
CT and tympanocentesis
Self-limited vertigo
No vomiting or LOC
Nystagmus
1-4 yo
Strong family h/o migraines
Benign paroxysmal vertigo of childhood
Most common causes of rhinitis
Allergy
Sinusitis
Polyps
Cystic fibrosis
Foreign body
Causes of nasal polyps
Cystic fibrosis (most common)
Aspirin sensitivity
Asthma
Allergic rhinitis
Chronic/recurrent sinusitis
Cyanosis while feeding
Resolution with crying
Bilateral choanal atresia
Common bacteria of sinusitis
Pneumococcus
H flu
Moraxella
When sinuses develop
Maxillary
Ethmoid
Frontal
Sphenoid
Birth
Birth
5-6 years
5-6 years
Study of choice for chronic recurrent sinusitis
CT
Unilateral
Blood tinged
Nasal discharge
Foul odor
Nasal foreign body
Recurrent/worsening epistaxis
Posterior nasopharyngeal angiofibroma
Reasons for recurrent strep pharyngitis symptoms following treatment
Chronic carrier state (repeat cultire)
Second infection
Noncompliance
Strep + HSM
Mono
EBV or CMV
Diagnostic eval for mono
> 4 yo: monospot
< 4 yo: viral-specific IgM
Sexually active teenager
Erythematous patches
Gonococcal pharyngitis
Widening of retropharyngeal space or if the paravertebral soft tissue
Retropharyngeal abscess
Indications for tonsillectomy
Repeated infections
—7 in 1yr
—5 per year x2
—3 per year x 3
Airway obstruction
Malignancy
Indications for adenoidectomy
Chronic sinusitis
Chronic adenoiditis
OSA
Complications of T&A
Hypernasal voice
Velopharyngeal insufficiency
Biphasic stridor
Refusal to lay down
Leaning forward
Drooling
“Thumb sign”
Treatment
Epiglottitis
Airway management
Ceftriaxone
4-5mm ulcers
Posterior oral cavity
Spares gums and tongue
Herpangina
Coxsackievirus group A
Grayish-white coagulum
Thin rim of bright erythema
Aphthous ulcer
(Canker sore)
Tender red nodule on cheek
Deep seated plaques and nodules
Infant
Cold-induced panniculitis
Normal waiting time for first toot eruption
16 mo
Common causes of delayed eruption
Hypothyroid
Hypopituitarism
Ectodermal hypoplasia
Hypohidrosis
Rickets
Transportation of Avulsed permanent tooth
Saliva or milk
Micrognathia
Posteriorly displaced tongue
U-placed cleft palate
Pierre Robin sequence
(Failure of mandible to grow properly)
When to repair cleft lip
10 weeks
When to repair cleft palate
9-12 mo
+ pressure equalizing tubes
Syndromes associated with cleft palate
Pierre robin
Crouzon
Apert
Treacher collins
Treatment of choice for OSA
Adenoidectomy
Most likely cause for post T&A (for OSA) respiratory distress
Pulmonary edema
Causes of inspiratory stridor
4-6 wk: laryngo/tracheomalacia
1-4 yr: croup, Epiglottitis, foreign body
> 5 yo: vocal cord dysfunction, PTA, anaphylaxis
Tonsillar/adenoid hypertrophy
Masses
Most common cause of congenital stridor
Laryngomalacia
Suprasternal/subcostal retractions
Stridor worsens with agitation
Stridor worsens in supine position
Stridor improves with expiration and time
No feeding difficulties
Laryngomalacia
Blunted inspiratory loop on spirometer
Weak, high-pitched cry
Diagnostic evaluation
Vocal cord paralysis
Flex nasolaryngoscopy or direct laryngoscope
CXR
Barium swallow
Progressive, chronic hoarseness
No stridor or dysphagia
Vocal cord nodules
Expiratory stridor
Feeding difficulties
Diagnostic evaluation
Vascular ring
Barium swallow
Biphasic stridor
Diagnostic evaluation
Subglottic stenosis
Direct laryngoscope and bronchoscopy
Steeple sign on CXR
Subglottic narrowing
Croup
Barky nonproductive cough
Allergies
Psychological
No URI or fevers
Spasmodic croup
Preauricular adenoapthy
Conjunctivitis
Adenovirus
Neck mass
Reactive
Mobile
Tender
Not warm or erythematous
Cervical adenopathy
Bilateral cervical lymphadenitis
Viral
Unilateral lymphadenitis
Treatment
Bacterial
Augmentin + clindamycin
Neck mass
Infected
Tender
Red and warm
Lymphadenitis
Persistent sun mental and submandivular lymph node swelling
PPD < 10 mm
Violaceous (purplish) hue
Management
Atypical (NonTB) mycobacteria
Leave it alone
Cervical adenitis not improving with antibiotics
Mycobacterium TB
(Positive IGRA)
Nontender lymph node
Nonmobile
Neoplasm/malignant
1 congenital cyst in the neck
Thyroglossal duct cyst
Midline anterior neck lesion
Moves upward with swallowing or sticking tongue out
Thyroglossal duct cyst
Mass of dilated lymph vessels
Turner syndrome
Cystic hygroma
Remnant located anterior to sternocleidomastoid muscle
Branchial cleft remnant
Cystic mass
Pea sized
Overlying pore
Anterior sternocleidomastoid muscle
Branchial cleft cyst
