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NPLEX II TIA > ENT > Flashcards

ENT Flashcards

1
Q

Causes of tympanosclerosis

A

Secondary to repeat trauma, infxn, perforations, and age

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2
Q

How does serous effusion present?

A

Bubbles/fluid line
Often associated with poor drainage of auditory tubes and middle ear and can allow bacteria to grow

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3
Q

What is an infectious process with bacterial overgrowth in middle ear?

A

Otitis media with prurulent effusion (OME)

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4
Q

What is bullous myringitis?

A

Vesicular infxn ON the TM
Viral in most cases, can be mycoplasma
Generally an indication to NOT rx abx

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5
Q

What do serous effusions, OME, and bullous myringitis have in common?

A

All have sequele of TM rupture

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6
Q

Conductive vs sensorineural hearing loss

A

conductive - can’t transmit sound waves;
kids/younger adults may seem better in noisy places, own voice is soft, visible abnormality (except in otosclerosis)

Weber - lateralizes to bad ear, Rinne BC > AC, AC=BC

SN - can’t neurologically process sound waves;

middle/later years, upper tones often lost, hearing worse in loud environment, own voice may be loud (they can’t hear it), problem not visible

Weber - Lateralizes to good ear, Rinne- AC > BC

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7
Q

Three tonsillar tissues

A

Lingual
Palatine
Pharyngeal (adenoid)

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8
Q

Ddx sore throat

A

Tonsillitis - inflammation of lymphatic tissue; usually self limited, rarely can cause airway issues

Pharyngitis - inflammation of pharynx and sometimes tonsillar tissues

Abscess - dangerous infxn in deeper tissues; can be deadly

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9
Q

Tonsillar swelling grades

A

Based on 25% each of oropharyngeal opening to midline

0 - none
4- tonsils touch in center

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10
Q

What are the major dangers of abscesses in the throat?

A

Sepsis
Airway obstruction

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11
Q

Different types of pharyngitis ***

A
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12
Q

Tx abscesses in throat

A

Abx
Dexamethasone

If not better > ENT drains

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13
Q

Centor criteria

A

Group A BH strep; should you test for strep

Exudates, tender ant cervical LA, fever, absence of cough, <15 (extra), 15-25

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14
Q

What is a thyroglossal duct cyst? How is it treated?

A

Midline swelling; goes all the way back to pre-vertebral area needs surgery

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15
Q

What is the most common congenital cyst formation in the neck?

A

Branchial cleft cysts (benign)

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16
Q

How do brachial cleft cysts present?

A

Large swellings on side of neck, pops out between scalenes when turns head

Benign, need to be removed

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17
Q

Etiologies of facial paralysis

A

Idiopathic (Bell’s palsy) - acute onset, viral prodrome
Trauma - sudden/acute
Herpes zoster - Ramsay hunt
Tumor - slow progression
Infxn/inflammation - mastoiditis, OM, Lyme, CN
Birth
Brain/CNS lesion

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18
Q

How is Bell’s palsy dx?

A

Only CN 7 involvement, hemiplegic paralysis

Otherwise, get imaging

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19
Q

Etiologies of epistaxis

A

HTN
Anticoags
Tumors (bleeding wont stop)

Trauma/surgery, barometric changes, structural deformities, inflammatory, tumor, HTN, hepatic/renal failure, coagulation disorders, drugs, valvular disorders

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20
Q

Epiglottitis presentation, dx, tx

A

H flu, BH strep
Sudden onset fever, drooling, toxic appearing

DONT OPEN THEIR MOUTH

Lateral cervical radiograph (thumbprint sign)

IMMEDIATE ER REFERRAL

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21
Q

Retropharyngeal abscess presentation, dx, and tx

A

Child/adult (trauma); fever, sore throat, stiff neck, no trismus (jaw spasm)

Lateral cervical radiograph or CT

Stabilize airway, surgical drainage, abx

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22
Q

Ludwig angina presentation, dx, and tx

A

Submaxillary, sublingual, or submental mass with elevation of tongue, jaw, swelling, fever, chills, trismus

Lateral cervical radiograph or CT

Stabilize airway, drain abscess, abx (penicillin, metronidazole)

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23
Q

Peritonsillar abscess presentation, dx, and tx

A

Swelling in peritonsillar region with uvula pushed aside, fever, sore throat, dysphagia, trismus

Cervical radiograph or CT
Aspiration of region with pus

Abscess drainage, abx

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24
Q

Presentation + etiology of laryngeal cancer

A

Tobacco smoke
30-50% has Mets at sx

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25
Q

Presentation + etiology of upper respiratory polyps

A

Reactive nodes that rarely become cancerous

Vocal cords of heavy smokers or singers, men

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26
Q

Presentation + etiology of Leukoplakia of larynx

A

Any hyperkeratotic lesion
Benign or malignant, depends how much atypia present

Strongly correlated with tobacco and alcohol

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27
Q

What is ear retraction?

A

TM retraction = pressure in external versus internal ear is imbalanced > dizziness, esp if uneven R to L

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28
Q

Abx generally used for ear complaints

A

Penicillins, macrolides

Sometimes fluouroquinolones

Macrolides and tetracyclines for mycoplasma

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29
Q

What are important things to consider in a pt with tinnitus?

A

Ototoxic drugs - salicylates (aspirin), cinchona alkaloids (quinine, quinidine), lots others

Thyroid, adrenal issues

Trauma

30
Q

work up for dizziness/vertigo

A

BP/vitals, neuro exam, HEENT, chest and abdomen screening

MRI in all recurrent cases, and all acute cases with no peripheral explanation

CT sinuses

CMP, CBC, RBC element profile

31
Q

In terms of “red eye” - what findings should you key in on?

A
  • pattern of injection (conjunctival, ciliary, or hemorrhagic)
  • level of (or presence of) pain (constant, with blinking, with movement)
  • visual disturbance
  • presence or level of photophobia
32
Q

In terms of “red eye” - What are your common ddx?

A

Conjunctivitis (v, bac, all, toxic)
Conjunctival hemorrhage
Keratitis (corneal irritation)
Corneal injury
Iritis/uveitis
Scleritis
Acute glaucoma attack

33
Q

Ciliary vs peripheral/conjunctival flush/injection

A

Ciliary - deeper
Peripheral/conjunctival - peripheral vasculature

Tells you if its “bad” or “good” red eye

34
Q

Which types of red eye have ciliary vs conjunctival hemorrhage?

A

Conjunctival - conjunctivitis, sub conjunctival hemorrhage

Ciliary - corneal injury or infxn, acute iritis, acute glaucoma

35
Q

Name the pathology:

Red eye with ciliary flush, cloudy cornea, plasmoid aqueous

A

Acute ant uveitis/iris in a pt with UC/IBD

EMERGENCY > can cause blindness

36
Q

Etiologies of acute uveitis

A

Trauma, inflammation in adjacent tissue, acute episode of a chronic condition (chrohns)

37
Q

Etiologies of chronic uveitis

A

Systemic disease such as Bechets, IBD, juvenile RA, reiters, sarcoidosis, syphilis, TB, Lyme

38
Q

Name the pathology: Red eye with diffuse ciliary injection and corneal clouding

A

Acute angle closure glaucoma

Painful

EMERGENCY to save eye and sight

39
Q

Presentation of acute angle closure glaucoma

A

Fluid drain becomes blocked; ant chamber is shallow, filtration angle narrowed, iris may obstruct entrance of schlemm or pupil may become blocked

Unilateral severe pain and rapid loss of vision
Possible N/V
Prodrome sx (transitory episodes of diminished visual acuity, colored halos around lights, pain in eye and head)

Hazy cornea (hypopion), fixed mid dilated pupil, eye firm to palpation

40
Q

Hallmark signs/sx of orbital cellulitis

A

Systemic signs/sx of infection and lid/EOM dysfunction

EMERGENCY > CLOSE TO BRAIN

41
Q

keratitis tx

A

Cornea involvement (MUST REFER TO EYE DR/ER) > can scar and blind

42
Q

What is Hutchison sign?

A

Zoster coming down to nose > affecting CN to eye > can lead to blindness

43
Q

Conjunctivitis presentation

A

No pain
Clear cornea

44
Q

Presentation, tx of retrobulbar (optic) neuritis

A

Pain on eye rotation
Inflammatory disorder
Typically self limited (NSAIDS)
May indicate systemic dz (orbital cellulitis, recurrent neuritis > MS)

45
Q

Presentation, tx of Ocular/atypical migraine

A

Pain with eye movement
Photophobia

Ddx by doing EOM in dark room

46
Q

Normal fundus

A

Normal cup/disc, lateral to disc is macula

47
Q

Eroded/large cup/disc ratio is indicative of what

A

Chronic Glaucoma

48
Q

All forms of age related macular degeneration have initial common destructive changes in the _______-

A

Macular retinal pigment epithelium

49
Q

Dry vs wet macular degeneration

A

Dry: RPE degeneration, vascular failure, loss of photoreceptors

Wet: all of above plus neurovascular component (leakage of plasma, lipid, glucose into choroid and retina > fibrous disciform scar formation)

50
Q

Vision loss patterns macular degeneration vs glaucoma

A

MD: central vision loss (dec in eye chart acuity and central on perimetry)

Glaucoma: peripheral vision loss/“tunnel vision” (dec in peripheral vision on perimetry)

51
Q

Nutrients/supp for macular degeneration

A

Taurine
Zinc
Selenium
Antioxidants
Carotenoids
Vit C, E
Vaccinum myrtilus, ginkgo biloba and crataegus

52
Q

Arteriosclerosis vs atherosclerosis

A

ARTERIO - trouble with artery wall, “hardening of arteries” (small artery, big vein)

ATHERO - atheroma or lesion inside vascular lumen

53
Q

Changes seen in HTN retinopathy?

Where else might you see these changes?

A

Hard leaking exudates, flame hemorrhage (blow out end of arterioles), cotton wool spots (scarred flame hemorrhages), papilledema, copper wire, silver wire

HIV retinopathy, renal disease retinopathy

54
Q

What is the pathophysiology behind diabetic retinopathy?

A

Excess sorbitol destroys pericyte cells that support vascular epithelium > inc leakage of blood, protein, lipids > vascular insufficiency > retinal hypoxia

Release of angiogenic factors > neovascularization (poor quality, leak) > cont cycle

55
Q

Retinal detachment presentation, dx, tx

A

Signs/sx: sudden onset single/multiple floating spots, flashes of light. Recent hx trauma to head/eye. Vitreous hemorrhage > multiple floaters. Vision loss

Binocular indirect ophthalmoscopy

EMERGENCY - lie supine and wait for transport to ER

56
Q

Presentation, dx, tx posterior vitreous detachment

A

Due to aging and dec hyaluronic acid > lack of collagen integrity > vitreous collapses forward

50+, acute onset floaters with one large floating spot. If dec in vision > vitreous hemorrhage

Direct referral for evaluation

57
Q

Lipemia retinalis vs atherosclerosis

A

Atherosclerosis - only Arteries change color/lighten

Lipemia - fat in all of the tree from high blood lipids

58
Q

Presentation, dx, tx

A

Hereditary degenerative process of rod cells

Slow progressive BL loss of night vision > dec central vision. Ring scotoma on perimetry, “bone spicule” pigment changes

No tx, some use Vit A - AVOID Vit E

59
Q

Common bugs blepharitis

A

Staph or strep

60
Q

What is a hordeolum?

A

Stye; painful tender red infection around hair follicle on eyelid margin of eyelashes

External: glands of zeis or moll
Internal: meibomian glands

61
Q

What is parotitis?

A

Infection of parotid gland; viral/mumps most common

62
Q

What is herpangina?

A

Acute febrile illness associated with small vesicles on post oropharyngeal structures (soft palate, uvula)

Occur during summer, typically mild and self limiting

63
Q

Etiologies of glossitis

A

Iron def
Pellagra
B12/folate def
Scurvy
Scarlet fever
EBV associated hairy leukoplakia

64
Q

What is stomatitis?

A

Canker sore

65
Q

Work up and tx for oral thrush

A

KOH wet punt with hyphae, pseudo hyphae, budding yeast cells

Tx: nystatin, fluconazole if severe

66
Q

What are the forms of oral cancer?

A

Gingival, tongue, tonsillar

67
Q

Presentation, tx of Meniere dz

A

Progressive condition affecting labyrinth > vertigo, tinnitus, hearing loss episodes

No sure, sx management only

68
Q

What is a Cholesteatoma?

A

Desctructive and expanding growth of keratinizing squamous epithelium in the middle ear and/or mastoid process

69
Q

Causes and sx of retinal hemorrhage

A

Diabetic retinopathy
Retinal vein occlusions
Ocular ischemic syndrome
Sickle cell retinopathy

Sx: floaters

70
Q

What is CMV retinitis? What is the presentation and workup?

A

Retinitis most common manifestation in pts who are HIV+

Blurred vision, floaters, progressive blinding, necrotizing retinitis with retinal hemorrhage, esophagitis, ulcers, colitis, fever

Culture, PCR, exam shows “cottage cheese and ketchup”

NPLEX II TIA (15 decks)

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