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Pulmonary > ENT > Flashcards

ENT Flashcards

1
Q

Three upper respiratory bacteria to always consider?

A

H. inf, S. pneumo, Moraxella catarrhalis

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2
Q

Difference in bacteria above and below the gingival margin?

A
  • above = facultative

- below = anaerobic

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3
Q

Four organisms found above the gingival margin?

A

Strep spp., Lactobacillus, Enterobacteriaceae (more in chronically ill patients), Moraxella

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4
Q

Six organisms found below the gingival margin?

A
  • Peptostrep
  • Actinomyces
  • Fusobacterium
  • Spirochetes
  • Prevotella
  • Veillonella
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5
Q

Three special pathogens associated with ENT system?

A
  • Corynebacterium diphtheria
  • S. aureus
  • P. aeruginosa
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6
Q

Top four viruses responsible for the common cold?

A
  • Rhinovirus
  • Influenza
  • Coronavirus
  • Adenovirus
  • Others are paramyxoviruses
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7
Q

What is the term for inflammation of mucous membranes lining the nose often associated with nasal discharge?

A

Coryza

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8
Q

Two common causes of serous otitis media associated with Eustachian tube dysfunction?

A

viral infection and allergic disease –> blockage and fluid build-up

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9
Q

Why are children more prone to middle ear infections?

A

Eustachian tube is more horizontal

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10
Q

What kind of treatment does malignant otitis externs warrant?

A
  • systemic IV antibiotics

- hospitalization

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11
Q

Two common bacterial causative agents of purulent otitis media?

A

S. pneumo and H. inf

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12
Q

Three complications associated with purulent otitis media?

A
  • conductive hearing loss
  • mastoiditis
  • meningitis
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13
Q

What is the most common manifestation of otitis media in adults?

A

serous otitis media (viral, allergic)

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14
Q

Three symptoms of otitis media serous?

A
  • ear FULLNESS (vs. pain in purulent cases)
  • popping with jaw movement
  • decreased hearing
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15
Q

Causes of acute and chronic forms of otitis externs?

A
  • acute = 50% P. aeruginosa

- chronic = >3 months, fungal and allergic dermatitis

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16
Q

How can the tragus sign be used to distinguish otitis media and externa?

A
    • for pain in otitis externa

- negative for pain in otitis media

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17
Q

Complication of otitis externa?

A

malignant otitis externa

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18
Q

Who gets malignant otitis externa?

A
  • IC
  • poorly controlled DM
  • transplant patients
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19
Q

Two pathogens associated with malignant otitis externa? Two complications?

A
  • P. aeruginosa and S. aureus (cellulitis)

- systemic infection and osteomyelitis

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20
Q

Drainage to superior meatus?

A
  • sphenoid

- posterior ethmoid air cells

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21
Q

Drainage to middle meatus?

A
  • frontal, maxillary, anterior and middle ethmoid air cells
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22
Q

Drainage to inferior meatus?

A

lacrimal duct

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23
Q

What can sinus transillumination be used to diagnose?

A
  • EXCLUDE maxillary sinusitis (sensitive but not specific)
  • frontal sinusitis
  • detects opacification of sinuses
24
Q

Four complications of acute sinusitis?

A
  • periorbital cellulitis
  • meningitis
  • subdural empyema
  • cranial sinus thrombosis
25
Q

What causes Pott’s puffy tumor?

A
  • initial trauma breaks skin of forehead

- frontal sinusitis develops and causes osteomyelitis of the calvarium

26
Q

Four complications seen with Pott’s puffy tumor?

A
  • scalp abscess
  • brain abscess
  • chronic osteomyelitis of frontal bone
  • subdural empyema
27
Q

Why enzyme produced by mucormycosis allows it to proliferate well in poorly controlled diabetics?

A
  • ketone reductase
  • poorly controlled DM are often in diabetic ketoacidotic state
  • mucor can survive on the ketones
28
Q

Invasion of rhino cerebral mucormycosis? Tx?

A
  • sinuses, orbit, brain

- best chance is IV anti-fungals and surgery

29
Q

When you see necrotic nasal eschar, think…

A

rhinocerebral mucormycosis

30
Q

What factors are associated with acute necrotic ulcerative gingivitis?

A
  • poor nutrition
  • smoking
  • bacterial overgrowth
31
Q

What is and who gets noma (canchrum oris)? Mortality?

A
  • anaerobic infection that begins as non-odontogenic and progresses to face via gingiva
  • severely malnourished children
  • 70-90%
32
Q

When are sulfur granules seen?

A
  • Orofacial actinomycosis

- yellow granules observed in pus that consist of WBC’s containing actinomyces

33
Q

Progression of orofacial actinomycoses? Tx?

A
  • arises from gingival crevice
  • associated with poor dentition and causes slowly developing purulent jaw abscess and lung infections
  • PENICILLIN
34
Q

Three predisposing conditions to oral candidiasis (thrush)?

A
  • steroids (poor technique w/ inhaled steroids)
  • diabetes
  • IC (HIV/AIDS)
35
Q

What causes a painless white plaque of the tongue that is difficult to scrap off?

A

Oral candidiasis (thrush)

36
Q

What virus is causative in Kaposi’s sarcoma and who gets it?

A
  • HHV-8

- IC (HIV/AIDS)

37
Q

Where do Kaposi’s sarcomas usually appear on the body? What are they?

A
  • palate, gingiva, skin, viscera

- hyperplastic purple vascular lesions

38
Q

What is oral leukoplakia and what should be done about it?

A
  • white plaques anywhere on oral mucosa
  • may be response to chronic irritation, pre-malignant lesion
  • BIOPSY
39
Q

What virus is hairy leukoplakia associated with? Where is it seen?

A
  • EBV-induced epithelial hyperplasia in HIV/AIDS patients

- corrugated white lesion seen on lateral aspect of tongue

40
Q

Typical causal agent of acute epiglottitis?

A

H. inf Type B (HiB)

41
Q

Radiological sign of acute epiglottitis?

A
  • thumb sign in lateral neck film

- enlarged epiglottis appears like a thumb

42
Q

If exudate is present in acute pharyngitis, what 5 organisms should be suspected?

A
  • GAS
  • EBV
  • HSV
  • adenovirus
  • Gonorrhea
43
Q

Three clinical S&S associated with GAS pharyngitis?

A
  • exudate
  • ipsilateral tender tonsillar LN
  • fever
44
Q

If bilateral tonsillar notes are palpated in associated with acute pharyngitis, what virus should be suspected?

A

EBV

45
Q

Untreated GAS pharyngitis is a risk for…

A

rheumatic fever

46
Q

What is Lemierre’s syndrome?

A

odontogenic/pharyngitic anaerobic infection that extends into carotid sheath producing septic thrombosis of internal jugular vein

47
Q

What lung symptoms are associated with Lemierre’s?

A

infected thromboemboli travel to lungs producing nodules and masses

48
Q

Three predisposing factors to Lemierre’s?

A

DM, malnutrition, smoking

49
Q

4 clinical signs of Lemierre’s?

A
  • fever
  • SCM and jaw angle tenderness
  • neck stiffness
  • dysphagia
50
Q

Where is the cervical danger space found and what does it allow access to?

A
  • between alar fascia and pre vertebral fascia posterior to the retropharyngeal space
  • allows access to diaphragm
51
Q

What is Ludwig’s angina?

A

begins as odontogenic infection that progresses to submandibular space

52
Q

Complications associated with Ludwig’s angina? Tx?

A
  • elevated tongue and floor of mouth pushes into roof of the mouth causing airway obstruction
  • antibiotics and surgical debridement (+ tracheostomy)
53
Q

In addition to antibiotics, what do closed source infections require for treatment?

A

SOURCE CONTROL - drainage, debridement

54
Q

Gram stain morphology of C. diphtheria?

A

GPB

55
Q

What are most C. diphtheria symptoms due to?

A

toxin elaboration

56
Q

Two unique exam findings associated with C. diphtheria?

A
  • pseudomembrane
  • bull’s neck adenopathy
  • also pharyngitis, fever, malaise, hoarseness; carditis and neuropathy

Pulmonary (7 decks)

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