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Surgery Subspecialties > ENT > Flashcards

ENT Flashcards

1
Q

Ludwig’s angina

A

floor of the mouth cellulitis/infection that causes the tongue to be retracted and obscure the airway

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2
Q

Epistaxis results from bleeding from ______ plexus. How do you treat it? What if it’s epistaxis from the posterior region in a juvenile male?

A
  • Kiesselbach’s plexus
  • packing or nasal vasoconstrictor
  • juvenile nasopharyngeal angiofibroma until proven otherwise
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3
Q

Emergency airway can be treated with ____, ____; also ____ except for when there’s cribiform plate rupture

A
  • cricothyrotomy
  • tracheotomy
  • nasotracheal intubation
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4
Q

to work up hearing loss you first use ______

A

tympanometry

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5
Q

Describe type A-C findings on tympanometry

A

A - normal
B - rigid TM (OM, TM perf)
C - negative pressure in middle ear (ET abnormality)

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6
Q

Benign positional vertigo

  • cause
  • how long does it last
A
  • free floating sediment

- <1 min

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7
Q

Vestibular neuronitis (labyrinthisis) is a/w _____ and tends to last _____ days

A
  • URI

- 1-2

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8
Q

Meniere’s Disease is from _______ and lasts _______

A
  • distension of endolymph

- 30 min - 4 hrs

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9
Q

Subglottic stenosis is often d/t ____(2).

- How is it treated?

A
  • intubation in the NICU, cricoid hypertrophy

- cricoid splint

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10
Q

Inspiratory stridor involves what structures? ex?

A
  • supraglottic (laryngomalacia)
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11
Q

Bidirectional stridor involves what structures? ex?

A
  • glottic (croup)
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12
Q

Expiratory stridor involves what structures?

A
  • lungs, bronchi, etc.
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13
Q

_____/_____is a large, expanding neck mass that often requires surgical intervention d/t airway obstruction

A

lymphangioma/cystic hygroma

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14
Q

presbycusis

A

high frequency hearing loss w/age

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15
Q

Otitis externa is common in _____ (3) types of patients

A
  • swimmers (swimmer’s ear)
  • DM
  • immunocompromised
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16
Q

S/Sx of OE (4)

A
  • PAIN
  • ITCHING
  • edematous, erythematous ear canal
  • +/- purulent discharge
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17
Q

OE:

  • doesn’t present like OM in that _____
  • Check for ______
  • If all else is negative think of ____
A
  • OM doesn’t present with pain on pulling the pinna
  • CN VII
  • otalgia
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18
Q

What organisms usually cause OE? (3)

A
  • Bacteria: pseudomonas

- Fungus: aspergillus or candida

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19
Q

OE tx

A
  • clean ear, abx drops (neomycin hydrocortisone)
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20
Q

When do you give oral abx in cases of OE? (3)

A
  • if the infection spreads beyond the external ear
  • if pt is DM
  • if pt is immunocompromised
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21
Q

In cases of OE (esp. in diabetics) always watch for ______

A

necrotizing/malignant OE

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22
Q

necrotizing OE/malignant OE natural history…

A

infects the temporal bone, skull base which then leads to meningitis, brain abscess, and death

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23
Q

S/Sx of NOE

A
  • granulation tissue in ear canal
  • h/a
  • purulent drainage (otorrhea)
  • deep ear pain
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24
Q

Culprit organism in NOE

A

psuedomonas

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25
Q

In what patients do you most commonly see NOE

A
  • poorly controlled diabetics

- elderly

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26
Q

What’s the treatment for NOE?

A
  • IV/PO Cipro x 6wks
  • daily DBT
  • Underlying condition control
  • abx drops
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27
Q

Bullous myringitis

A

blisters on the ear drums 2/2 m.pneumonia

- self limited

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28
Q

s/sx of bullous myringitis (BM)

A
  • pain (otalgia) w/mobile TM
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29
Q

Tx of BM

A
  • oral abx (?erythro)
  • pain meds
  • bulla drainage
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30
Q

You typically see OM in ______ after _____

A
  • children

- URI

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31
Q

What are the demographics of OM with regard to

  • gender
  • race
A
  • boys > girls

- whites > blacks

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32
Q

What are the peak ages for OM?

A
  • 6-11 mos.

- 4-5 yrs.

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33
Q

_____ is protective against OM

A

breast feeding

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34
Q

_______ (5) increase kids risk of OM

A
  • smoking and exposure
  • cleft palate
  • immunodeficiency
  • kartageners
  • trisomy 21
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35
Q

When an adult presents w/OM rule out _____

A

nasopharyngeal cancer

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36
Q

What are the most common culprits of OM

A

S. pneumo > H. influenza > M. catarrhalis

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37
Q

S/Sx of OM (5)

A
  • ear pain
  • fever
  • irritability
  • tugging at ears
  • discharge
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38
Q

acute OM lasts _____, chronic OM lasts _____

A
  • 3 mos.
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39
Q

What makes OM “recurrent”?

A

3+ in 6 mos.

4+ in 12 mos.

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40
Q

Complications of OM? (3)

A
  • swelling
  • disequilibrium
  • facial palsy
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41
Q

Exam findings for OM

A
  • erythematous/bulging TM

- loss of light reflex

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42
Q

Tx of OM

- if no change in 2-3 d?

A
  • amoxicillin x 10 d
  • if <6 mos. treat w/low threshold
  • if no change in 48-72 hrs add beta lactamase inhibitor (augmentin)
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43
Q

If recurrent OM, how do you treat?

A
  • tympanocentesis

- myringotomy w/tympanostomy tubes

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44
Q

What are the indications for tympanocentesis/myringotomy w/tympanostomy? (3)

A
  • neonates
  • no response to abx
  • immunocompromised
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45
Q

What are some of the potential complications of OM? (6)

A
  • perforation
  • bullous myringitis
  • effusion
  • subperiosteal abscess
  • mastoiditis
  • cholesteatoma
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46
Q

s/sx of OM w/effusion

A
  • usually asx
  • can present w/chronic conductive hearing loss
  • usually resolves spontaneously after 1 mo; mean duration 40 d
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47
Q

Tx of OM w/effusion

A
  • myringotomy tube insertion w/ or w/o adenoidectomy if high risk or significant hearing loss
  • when combined w/adenoidectomy yields the best results
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48
Q

cholesteotoma

A
  • 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
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49
Q

mastoiditis

- how do you diagnose this?

A

infected fluid in the air cells of the mastoid bone

- diagnos w/CT

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50
Q

Meningitis, facial nerve paralysis, petrositis, labrynthitis, sigmoid sinus thrombosis, cranial abscess can all be serious complications of _____.

A

OM

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51
Q

OM can cause facial nerve paralysis d/t _____

A

inflammation around the nerve

52
Q

Petrositis from OM can also result in ______

A

CN VI palsy

53
Q

Labrynthitis can result in what sx? (2)

A
  • hearing loss

- vertigo

54
Q

the cranial abscesses from OM would be where? How are these treated?

A
  • epidural, subdural, or cerebral

- drainage and possible mastoidectomy, myringotomy

55
Q

Rhinitis is inflammation of the ______ while sinusitis is inflammation of the ______

A
  • MMs of the nasal passage

- MMs of the sinuses

56
Q

Rhinitis is disease of the ______ complex. Why is this important?

A
  • OSTEOMEATAL COMPLEX (OMC)
  • minor swelling can result in obstruction and significant symptoms due to blockage of the maxillary, frontal, and ethmoid sinuses
57
Q

_____ separates the ethmoid sinus from the orbit

A
  • lamina propecia
58
Q

What are predisposing factors to rhinitis? (7)

A
  • 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
59
Q

What is the difference between rhinosinusitis (infection) and allergic rhinitis with regard to:
- nasal discharge

A
  • RS: thick

- AR: thin, watery

60
Q

What is the difference between rhinosinusitis (infection) and allergic rhinitis with regard to:
- sneezing/cough

A
  • RS: cough/irritability

- AR: paroxysmal sneezing

61
Q

What is the difference between rhinosinusitis (infection) and allergic rhinitis with regard to:
- nasal symptoms

A
  • RS: pressure w/pain

- AR: itchy, runny nose

62
Q

What is the difference between rhinosinusitis (infection) and allergic rhinitis with regard to:
- other associated sx/conditions

A
  • RS: toothache, fever

- AR: conjunctivitis, otitis, laryngitis, late phase w/eosinophilic infiltrate

63
Q

AR is a type ___ hypersensitivity rxn

A

1

64
Q

Samter’s triad

A
  • asthma
  • allergy to ASA
  • nasal polyps
65
Q

Describe the natural history of acute RS

A
  • 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
66
Q

What are diagnostic criteria for acute RS?

A
  • 2+ major factors
  • 1 major + 2 minor factors
  • nasal purulence on exam
67
Q

subacute RS duration

A
  • 4-12 WEEKS
68
Q

What are diagnostic criteria for subacute RS?

A
  • 2+ major risk factors

- >3 minor RFs

69
Q

Recurrent acute RS duration

A

4+ RS episodes/yr w/resolution of sx between episodes

70
Q

Chronic RS duration

A
  • 12+ WEEKS
71
Q

What is 2 important causes of chronic RS? Describe the disease process for the first

A
  • Kartageners - usually absence fo outer dynein arms

- asthma - exacerbates hyperreactivity

72
Q

People with Kartageners are predisposed to _____ (5 - not just ENT related)

A
  • Pseudomonas infections
  • Upper and lower resp infections
  • bronchiectasis
  • situs inversus
  • sterility
73
Q

The gold standard for dx of RS is

A

CT

74
Q

What are the indications for CT in the setting of RS? (2)

A
  • 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
75
Q

Rhinoscopy may be appropriate in the setting of RS to look for _____

A

structural and mucosal problems

76
Q

cultures are indicated for ____ RS

A
  • chronic
77
Q

What are the s/sx you look for on the allergic physical? (8)

A
  • shiners
  • conjunctivitis
  • retracted TM
  • boggy, pale mucosa
  • cobblestoning pharynx (post nasal drip)
  • nasal hypertrophy
  • dennies lines
  • edema
78
Q

What are the “major factors” of RS? (5)

A
  • facial pain/pressure
  • nasal obstruction/congestion
  • nasal discharge/purulence
  • hyposmia/anosmia
  • cough not 2/2 asthma
79
Q

What are the “minor factors” of RS? (7)

A
  • h/a
  • fever
  • halitosis (bad breath)
  • fatigue
  • dental pain
  • cough
  • otologic sx
80
Q

What are the bacterial bugs mostly responsible for RS? (hint - they’re the same as for OM)

A

SHaM

S. pneumo > H. influenzae > M. catarrhalis

81
Q

What is the fungal bug mostly responsible for RS? What are complications of an infection w/this?

A
  • mucormycosis
  • necrosis of the turbinates
  • spread to CNS (DM, IC pts)
82
Q

______ RS is usually chronic and does NOT go away

A
  • allergic fungal (fungal ball)
83
Q

Allergic fungal RS is marked by ____ and ___ which contains ______ (2)

A
  • polyps
  • allergic mucin
  • eosinophils, Charcot leyden crystals
84
Q

How do you treat allergic fungal RS? (3)

A
  • transnasal sinusotomy
  • oral steroids or antifungals
  • irrigation
85
Q

What are the treatment goals for RS? (4)

A
  • control infection
  • reduce edema
  • facilitate drainage
  • maintain patency
86
Q

When and how do you treat acute RS?

A
  • if worsening after 5 days or persisting longer than 10 days
  • Amoxicillin, augmentin
87
Q

How do you treat chronic RS?

A
  • 4+ wks of abx
  • adjuvant tx w/corticosteroids + decongestants + antihistamines
  • surgery if anatomic obstruction
  • ?staph is usually implicated?
88
Q

Complications of bacterial RS (3)

A
  • brain abscess - frontal sinusitis
  • subperiosteal orbital abscess –> ethmoiditis (early cellulitis –> abscess and proptosis)
  • cavernous sinus thrombosis
89
Q

Cavernous sinus thrombosis is a complication of ____ and this is usually an infection by what bug?

A
  • bacterial RS

- S. aureus

90
Q

Cavernous sinus thrombosis (sphenoid sinusitis) results from a _____ process of the ______ (3)

A
  • suppurative

- orbit, nasal sinuses, or central face

91
Q

S/sx of cavernous sinus thrombosis

A
  • sinusitis and double vision
  • H/a (most common)
  • AMS –> suggests sepsis or spread to CNS
92
Q

Dx of CST (4)

A
  • WBC
  • MRI
  • CSF cultures
  • biopsy of paranasal sinuses
93
Q

Tx of CST (3)

A
  • PCN + 3rd gen cephalosporin
  • Vancomycin
  • Metronidazole
94
Q

Congenital lateral neck mass

A

branchial cleft cyst (II most common)

95
Q

Branchial cleft cyst

tx?

A
  • firm, nontender
  • second cleft anomalies most common
  • surgical excision
96
Q

Congenital medial neck mass

A

thyroglossal duct cyst

97
Q

Thyroglossal duct cyst
etiology?
other?
tx?

A
  • remnant of duct from foramen cecum to the thyroid
  • firm, nontender
  • moves up and down through hyoid w/swallowing
  • surgical excision
98
Q

When an elderly person has a salivary gland infection cover for _____

A

S. aureus

99
Q

Bugs for epiglottitis (2)

A
  • H. influenzae B, strep
100
Q

Demographics for epiglottitis

A
  • 2-6 yos
101
Q

S/sx of epiglottitis (4)

A
  • rapidly progressive
  • acute onset fever
  • sore throat, drooling
  • inspiratory stridor, retractions
102
Q

Inspiratory stridor is a/w ____ (6)

A
  • epiglottitis
  • croup
  • vocal cord paralysis
  • FB
  • laryngomalacia
  • neoplasm
103
Q

In suspected epiglottitis do NOT ______

A

examine the throat

104
Q

Thumbprint sign

A

lateral x-ray finding in epiglottitis

105
Q

tx of epiglottitis

A

surgical emergency

106
Q

Pleomorphic adenoma is a type of _______

A

parotid tumor

107
Q

Management of pleomorphic adenomas

A
  • protect the eye/cornea via facial nerve sparing

- check facial nerve

108
Q

RFs for SCC of the larynx, oral cavity and oropharynx

A
  • smoking
  • HPV
  • EtOH
  • radiation
109
Q

What surgical emergency can SCC of the larynx/oral cavity/oropharynx result in?

A

paralysis of the vocal cords

110
Q

Tonsillitis/pharyngitis is inflammation of ______

A

palatine tonsils

111
Q

main cause of tonsillitis/pharyngitis?

A

b-hemolytic strep

112
Q

sx of tonsillitis/pharyngitis? (6)

A
  • dysphagia
  • odynophagia
  • otalgia
  • hoarseness
  • resp distress
  • drooling
113
Q

tx of tonsillitis/pharyngitis

A
  • must r/o mono first since PCN can cause nonallergic rash in 99%
  • PCN derivatives to treat - erythromycin, clindamycin
114
Q

When do you treat tonsillitis/pharyngitis w/a tonsillectomy? (4)

A
  • if recurrent
  • if chronic
  • sleep apnea
  • asymmetric
115
Q

Complications of tonsillitis/pharyngitis (5)

A
  • peritonsilar abscess
  • rheumatic heart disease
  • post strep GN
  • mediastinitis d/t retropharyngeal spread
  • guttate psoriasis (requires tonsillectomy)
116
Q

Tx of peritonsilar abscess

A

place needle superiorly and medially (to avoid the carotid artery)

117
Q

viral laryngotracheobronchitis, “barking cough” parainfluenza, and steeple sign on AP view all refer to ____

A

croup

118
Q

ages most affected by croup

A

6 mos to 2 yrs

119
Q

tx of croup

A
  • humidity
  • steroids
  • racemic epi
120
Q

Cricothyrotomy is an emergency procedure that requires puncturing between _____ and _____

A

thyroid cartilage

cricoid cartilage

121
Q

A tracheotomy is more permanent than a cricothyrotomy and is between ____ and ____

A
  • first and

- second tracheal rings

122
Q

What is the ONLY abductor muscle of the vocal ligaments?

A
  • posterior cricoarytenoid muscle (PCA)
123
Q

All cartilages of the pharynx are incomplete EXCEPT _____

A

cricoid cartilage

124
Q

All muscles of the pharynx are innervated by the recurrent laryngeal nerve EXCEPT _____

A

cricothyroid (superior laryngeal)

125
Q

Lefort III

A

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
126
Q

Malocclusion

A

misalignment of teeth or jaw after injury

  • may see mandible tenderness, blood in mouth
  • could point to mandibular fracture/trauma
127
Q

Monilia

A

candida albicans

Surgery Subspecialties (6 decks)

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