ENT Flashcards
Ludwig’s angina
floor of the mouth cellulitis/infection that causes the tongue to be retracted and obscure the airway
Epistaxis results from bleeding from ______ plexus. How do you treat it? What if it’s epistaxis from the posterior region in a juvenile male?
- Kiesselbach’s plexus
- packing or nasal vasoconstrictor
- juvenile nasopharyngeal angiofibroma until proven otherwise
Emergency airway can be treated with ____, ____; also ____ except for when there’s cribiform plate rupture
- cricothyrotomy
- tracheotomy
- nasotracheal intubation
to work up hearing loss you first use ______
tympanometry
Describe type A-C findings on tympanometry
A - normal
B - rigid TM (OM, TM perf)
C - negative pressure in middle ear (ET abnormality)
Benign positional vertigo
- cause
- how long does it last
- free floating sediment
- <1 min
Vestibular neuronitis (labyrinthisis) is a/w _____ and tends to last _____ days
- URI
- 1-2
Meniere’s Disease is from _______ and lasts _______
- distension of endolymph
- 30 min - 4 hrs
Subglottic stenosis is often d/t ____(2).
- How is it treated?
- intubation in the NICU, cricoid hypertrophy
- cricoid splint
Inspiratory stridor involves what structures? ex?
- supraglottic (laryngomalacia)
Bidirectional stridor involves what structures? ex?
- glottic (croup)
Expiratory stridor involves what structures?
- lungs, bronchi, etc.
_____/_____is a large, expanding neck mass that often requires surgical intervention d/t airway obstruction
lymphangioma/cystic hygroma
presbycusis
high frequency hearing loss w/age
Otitis externa is common in _____ (3) types of patients
- swimmers (swimmer’s ear)
- DM
- immunocompromised
S/Sx of OE (4)
- PAIN
- ITCHING
- edematous, erythematous ear canal
- +/- purulent discharge
OE:
- doesn’t present like OM in that _____
- Check for ______
- If all else is negative think of ____
- OM doesn’t present with pain on pulling the pinna
- CN VII
- otalgia
What organisms usually cause OE? (3)
- Bacteria: pseudomonas
- Fungus: aspergillus or candida
OE tx
- clean ear, abx drops (neomycin hydrocortisone)
When do you give oral abx in cases of OE? (3)
- if the infection spreads beyond the external ear
- if pt is DM
- if pt is immunocompromised
In cases of OE (esp. in diabetics) always watch for ______
necrotizing/malignant OE
necrotizing OE/malignant OE natural history…
infects the temporal bone, skull base which then leads to meningitis, brain abscess, and death
S/Sx of NOE
- granulation tissue in ear canal
- h/a
- purulent drainage (otorrhea)
- deep ear pain
Culprit organism in NOE
psuedomonas
In what patients do you most commonly see NOE
- poorly controlled diabetics
- elderly
What’s the treatment for NOE?
- IV/PO Cipro x 6wks
- daily DBT
- Underlying condition control
- abx drops
Bullous myringitis
blisters on the ear drums 2/2 m.pneumonia
- self limited
s/sx of bullous myringitis (BM)
- pain (otalgia) w/mobile TM
Tx of BM
- oral abx (?erythro)
- pain meds
- bulla drainage
You typically see OM in ______ after _____
- children
- URI
What are the demographics of OM with regard to
- gender
- race
- boys > girls
- whites > blacks
What are the peak ages for OM?
- 6-11 mos.
- 4-5 yrs.
_____ is protective against OM
breast feeding
_______ (5) increase kids risk of OM
- smoking and exposure
- cleft palate
- immunodeficiency
- kartageners
- trisomy 21
When an adult presents w/OM rule out _____
nasopharyngeal cancer
What are the most common culprits of OM
S. pneumo > H. influenza > M. catarrhalis
S/Sx of OM (5)
- ear pain
- fever
- irritability
- tugging at ears
- discharge
acute OM lasts _____, chronic OM lasts _____
- 3 mos.
What makes OM “recurrent”?
3+ in 6 mos.
4+ in 12 mos.
Complications of OM? (3)
- swelling
- disequilibrium
- facial palsy
Exam findings for OM
- erythematous/bulging TM
- loss of light reflex
Tx of OM
- if no change in 2-3 d?
- amoxicillin x 10 d
- if <6 mos. treat w/low threshold
- if no change in 48-72 hrs add beta lactamase inhibitor (augmentin)
If recurrent OM, how do you treat?
- tympanocentesis
- myringotomy w/tympanostomy tubes
What are the indications for tympanocentesis/myringotomy w/tympanostomy? (3)
- neonates
- no response to abx
- immunocompromised
What are some of the potential complications of OM? (6)
- perforation
- bullous myringitis
- effusion
- subperiosteal abscess
- mastoiditis
- cholesteatoma
s/sx of OM w/effusion
- usually asx
- can present w/chronic conductive hearing loss
- usually resolves spontaneously after 1 mo; mean duration 40 d
Tx of OM w/effusion
- myringotomy tube insertion w/ or w/o adenoidectomy if high risk or significant hearing loss
- when combined w/adenoidectomy yields the best results
cholesteotoma
- expanding/destructive growth of keratinized squamous epithelium of the middle ear (near pars flaccida)
- 2/2 retraction of the ear drum from negative pressure caused by chronic dysfunction of the eustachian tubes
mastoiditis
- how do you diagnose this?
infected fluid in the air cells of the mastoid bone
- diagnos w/CT
Meningitis, facial nerve paralysis, petrositis, labrynthitis, sigmoid sinus thrombosis, cranial abscess can all be serious complications of _____.
OM
OM can cause facial nerve paralysis d/t _____
inflammation around the nerve
Petrositis from OM can also result in ______
CN VI palsy
Labrynthitis can result in what sx? (2)
- hearing loss
- vertigo
the cranial abscesses from OM would be where? How are these treated?
- epidural, subdural, or cerebral
- drainage and possible mastoidectomy, myringotomy
Rhinitis is inflammation of the ______ while sinusitis is inflammation of the ______
- MMs of the nasal passage
- MMs of the sinuses
Rhinitis is disease of the ______ complex. Why is this important?
- OSTEOMEATAL COMPLEX (OMC)
- minor swelling can result in obstruction and significant symptoms due to blockage of the maxillary, frontal, and ethmoid sinuses
_____ separates the ethmoid sinus from the orbit
- lamina propecia
What are predisposing factors to rhinitis? (7)
- viral URI - most common reason is inflammatory obstruction following common cold/allergy
- allergic rhinitis
- anatomic OMC obstruction (like deviated septum, turbinate hypertrophy, polyps)
- air pollustion
- nasal polyposis
- meds
- pregnancy
What is the difference between rhinosinusitis (infection) and allergic rhinitis with regard to:
- nasal discharge
- RS: thick
- AR: thin, watery
What is the difference between rhinosinusitis (infection) and allergic rhinitis with regard to:
- sneezing/cough
- RS: cough/irritability
- AR: paroxysmal sneezing
What is the difference between rhinosinusitis (infection) and allergic rhinitis with regard to:
- nasal symptoms
- RS: pressure w/pain
- AR: itchy, runny nose
What is the difference between rhinosinusitis (infection) and allergic rhinitis with regard to:
- other associated sx/conditions
- RS: toothache, fever
- AR: conjunctivitis, otitis, laryngitis, late phase w/eosinophilic infiltrate
AR is a type ___ hypersensitivity rxn
1
Samter’s triad
- asthma
- allergy to ASA
- nasal polyps
Describe the natural history of acute RS
- lasts up to 4 WEEKS
- URI sx worse after 5 days OR persistent for 10 days
- sx out of proportion to those usually seen w/URI
What are diagnostic criteria for acute RS?
- 2+ major factors
- 1 major + 2 minor factors
- nasal purulence on exam
subacute RS duration
- 4-12 WEEKS
What are diagnostic criteria for subacute RS?
- 2+ major risk factors
- >3 minor RFs
Recurrent acute RS duration
4+ RS episodes/yr w/resolution of sx between episodes
Chronic RS duration
- 12+ WEEKS
What is 2 important causes of chronic RS? Describe the disease process for the first
- Kartageners - usually absence fo outer dynein arms
- asthma - exacerbates hyperreactivity
People with Kartageners are predisposed to _____ (5 - not just ENT related)
- Pseudomonas infections
- Upper and lower resp infections
- bronchiectasis
- situs inversus
- sterility
The gold standard for dx of RS is
CT
What are the indications for CT in the setting of RS? (2)
- questions of dx and tx
- strong hx of nonresponse
- Acute: spread of infection to extrasinus structures (orbit/brain)
- Chronic: after 4 wks of appropriate tx
Rhinoscopy may be appropriate in the setting of RS to look for _____
structural and mucosal problems
cultures are indicated for ____ RS
- chronic
What are the s/sx you look for on the allergic physical? (8)
- shiners
- conjunctivitis
- retracted TM
- boggy, pale mucosa
- cobblestoning pharynx (post nasal drip)
- nasal hypertrophy
- dennies lines
- edema
What are the “major factors” of RS? (5)
- facial pain/pressure
- nasal obstruction/congestion
- nasal discharge/purulence
- hyposmia/anosmia
- cough not 2/2 asthma
What are the “minor factors” of RS? (7)
- h/a
- fever
- halitosis (bad breath)
- fatigue
- dental pain
- cough
- otologic sx
What are the bacterial bugs mostly responsible for RS? (hint - they’re the same as for OM)
SHaM
S. pneumo > H. influenzae > M. catarrhalis
What is the fungal bug mostly responsible for RS? What are complications of an infection w/this?
- mucormycosis
- necrosis of the turbinates
- spread to CNS (DM, IC pts)
______ RS is usually chronic and does NOT go away
- allergic fungal (fungal ball)
Allergic fungal RS is marked by ____ and ___ which contains ______ (2)
- polyps
- allergic mucin
- eosinophils, Charcot leyden crystals
How do you treat allergic fungal RS? (3)
- transnasal sinusotomy
- oral steroids or antifungals
- irrigation
What are the treatment goals for RS? (4)
- control infection
- reduce edema
- facilitate drainage
- maintain patency
When and how do you treat acute RS?
- if worsening after 5 days or persisting longer than 10 days
- Amoxicillin, augmentin
How do you treat chronic RS?
- 4+ wks of abx
- adjuvant tx w/corticosteroids + decongestants + antihistamines
- surgery if anatomic obstruction
- ?staph is usually implicated?
Complications of bacterial RS (3)
- brain abscess - frontal sinusitis
- subperiosteal orbital abscess –> ethmoiditis (early cellulitis –> abscess and proptosis)
- cavernous sinus thrombosis
Cavernous sinus thrombosis is a complication of ____ and this is usually an infection by what bug?
- bacterial RS
- S. aureus
Cavernous sinus thrombosis (sphenoid sinusitis) results from a _____ process of the ______ (3)
- suppurative
- orbit, nasal sinuses, or central face
S/sx of cavernous sinus thrombosis
- sinusitis and double vision
- H/a (most common)
- AMS –> suggests sepsis or spread to CNS
Dx of CST (4)
- WBC
- MRI
- CSF cultures
- biopsy of paranasal sinuses
Tx of CST (3)
- PCN + 3rd gen cephalosporin
- Vancomycin
- Metronidazole
Congenital lateral neck mass
branchial cleft cyst (II most common)
Branchial cleft cyst
tx?
- firm, nontender
- second cleft anomalies most common
- surgical excision
Congenital medial neck mass
thyroglossal duct cyst
Thyroglossal duct cyst
etiology?
other?
tx?
- remnant of duct from foramen cecum to the thyroid
- firm, nontender
- moves up and down through hyoid w/swallowing
- surgical excision
When an elderly person has a salivary gland infection cover for _____
S. aureus
Bugs for epiglottitis (2)
- H. influenzae B, strep
Demographics for epiglottitis
- 2-6 yos
S/sx of epiglottitis (4)
- rapidly progressive
- acute onset fever
- sore throat, drooling
- inspiratory stridor, retractions
Inspiratory stridor is a/w ____ (6)
- epiglottitis
- croup
- vocal cord paralysis
- FB
- laryngomalacia
- neoplasm
In suspected epiglottitis do NOT ______
examine the throat
Thumbprint sign
lateral x-ray finding in epiglottitis
tx of epiglottitis
surgical emergency
Pleomorphic adenoma is a type of _______
parotid tumor
Management of pleomorphic adenomas
- protect the eye/cornea via facial nerve sparing
- check facial nerve
RFs for SCC of the larynx, oral cavity and oropharynx
- smoking
- HPV
- EtOH
- radiation
What surgical emergency can SCC of the larynx/oral cavity/oropharynx result in?
paralysis of the vocal cords
Tonsillitis/pharyngitis is inflammation of ______
palatine tonsils
main cause of tonsillitis/pharyngitis?
b-hemolytic strep
sx of tonsillitis/pharyngitis? (6)
- dysphagia
- odynophagia
- otalgia
- hoarseness
- resp distress
- drooling
tx of tonsillitis/pharyngitis
- must r/o mono first since PCN can cause nonallergic rash in 99%
- PCN derivatives to treat - erythromycin, clindamycin
When do you treat tonsillitis/pharyngitis w/a tonsillectomy? (4)
- if recurrent
- if chronic
- sleep apnea
- asymmetric
Complications of tonsillitis/pharyngitis (5)
- peritonsilar abscess
- rheumatic heart disease
- post strep GN
- mediastinitis d/t retropharyngeal spread
- guttate psoriasis (requires tonsillectomy)
Tx of peritonsilar abscess
place needle superiorly and medially (to avoid the carotid artery)
viral laryngotracheobronchitis, “barking cough” parainfluenza, and steeple sign on AP view all refer to ____
croup
ages most affected by croup
6 mos to 2 yrs
tx of croup
- humidity
- steroids
- racemic epi
Cricothyrotomy is an emergency procedure that requires puncturing between _____ and _____
thyroid cartilage
cricoid cartilage
A tracheotomy is more permanent than a cricothyrotomy and is between ____ and ____
- first and
- second tracheal rings
What is the ONLY abductor muscle of the vocal ligaments?
- posterior cricoarytenoid muscle (PCA)
All cartilages of the pharynx are incomplete EXCEPT _____
cricoid cartilage
All muscles of the pharynx are innervated by the recurrent laryngeal nerve EXCEPT _____
cricothyroid (superior laryngeal)
Lefort III
fracture to the maxilla/midface involving the maxilla, zygomatic bone, nasal bone, and orbit
- results in disarticulation of the face from the skull, maxillary structures are mobile
- complete b/l fracture is rare
- may have CSF leakage
Malocclusion
misalignment of teeth or jaw after injury
- may see mandible tenderness, blood in mouth
- could point to mandibular fracture/trauma
Monilia
candida albicans
