ENT Flashcards by Patricia Lee

What are 4 risk factors for head and neck cancer?

smoking
alcohol use
HPV infection
EBV infection

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What are 5 diagnostic considerations in the ddx of peritonsillar abscess

peritonsillar cellulitis
epiglottitis 
retropharyngeal cellulitis/abscess
parapharyngeal space cellulitis/abscess
severe tonsillarpharyngitis

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What are 5 ddx considerations in otitis externa?

otomycosis
contact dermatitis
psoriasis
carcinoma of the ear canal
chronic suppurative otitis media

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What is the nonoperative management strategy for parotitis?

MASH acronym
Massage
Analgesia +/- antibiotics
Sialogogues
Heat

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What are 5 complications of acute suppurative parotitis?

Deep space neck infection with sepsis
Airway obstruction
Osteomyelitis of facial bones
Septic jugular thrombophelbitis (Lemierre's)
Facial nerve palsy
Fistula

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What is the definition of chronic rhinosinusitis?

Inflammation of the nasal passages and paranasal sinuses >12 weeks

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What are the 4 cardinal features of chronic rhinosinusitis?

anterior or posterior mucopurulent nasal discharge
nasal obstruction/blockage/congestion
facial pain/fullness
reduction or loss of sense of smell
*in children sense of smell is replaced by cough

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What are the 4 facial sinuses?

Frontal
Sphenoid
Ethmoid
Maxillary

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What are the 2 mainstays of medical treatment in chronic rhinosinusitis?

nasal saline rinses

intranasal steroid sprays

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What is the definition of sudden sensorineural hearing loss?

acute (30 db in 3 different frequencies, idiopathic

often associated with tinnitus, vertigo

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Where is the localization of hearing loss in acute stroke?

anterior inferior cerebellar artery (AICA)

may be associated with ipsilateral horner’s syndrome, diplopia, nystagmus, facial weakness, limb/central ataxia, contralateral spinothalamic findings

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How does the Weber test work?

Place tuning fork on center of head
lateralizes to affected ear = conductive loss
lateralizes to opposite ear = sensorineural loss

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How does the Rinne test work?

Place tuning fork on mastoid - once patient ceases to hear it hold it next to ear
If AC > BC = normal
If BC > AC = conductive loss

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What is an alternative to the Weber test?

Hum test

If sound lateralizes to affected side = conductive loss

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What are 10 complications of acute otitis media?

Hearing loss
Vestibular problems (balance)
Labrynthitis
Cholesteatoma 
Facial nerve palsy
Perforated TM 
Chronic suppurative otitis media
Mastoiditis
Meningitis
Brain abscess
Epidural abscess
Lateral sinus thrombosis
Cavernus sinus thrombosis
Subdural empyema
Carotid artery thrombosis

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What are 10 non viral pharyngitis causes of sore throat?

Infectious mononucelosis
Epiglottitis
Retropharyngeal abscess
Foreign body aspiration
Diphtheria
Lemierre's syndrome 
Peritonsillar abscess
Herpes stomatitis
Hand foot and mouth syndrome
Steven Johnson Syndrome/TEN
Gonoccocal pharyngitis
Kawasaki's disease
Chemical exposure and injury
Candida esophagitis 
Referred pain from dental abscess, AOM
PFAPA

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What 3 systems contribute to balance equilibrium

Visual
Proprioception
Vestibular

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What are 8 causes of peripheral vertigo

BPPV
Vestibular neuritis
Labrynthitis
Meniere's disease
Foreign body
Acute otitis media
Perilymphatic fistula
Trauma (labrynth concussion)
Motion sickness
Acoustic neuroma

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What are 8 causes of central vertigo

CNS infection (encephalitis, meningitis)
Vertebral artery dissection
Cerebellar infarct/hemorrhage
Subclavian steal syndrome
Vertebral basilar artery steal syndrome
Vertebrobasilar migraine
Post traumatic injury (temporal bone fracture)
Post concussive syndrome 
Temporal lobe epilepsy
Tumor
Multiple sclerosis

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What are 4 important structures to identify and think about when landmarking the drainage of a PTA?

anterior tonsillar pillar = palatoglossus muscle
posterior tonsillar pillar = palatopharyngeus muscle
palatine tonsil
superior constrictor muscle

What is a risk factor for PTA development?

smoking

What are 2 major microbes that cause PTA?

Streptoccocus pyogenes
Staphylococcus aureus
mostly polymicrobial

What are clinical features of PTA?

unilateral throat pain
fever
muffled voice
trismus (in 2/3)
neck swelling
ear pain 
medial displacement of tonsil
uvula displacement

What is the recurrence rate of PTA post drainage?

5-10%

What are 5 complications of PTA?

``` Airway obstruction Aspiration of drainage Sepsis Group A Strep complications Internal jugular vein thrombosis Jugular vein suppurative thrombophlebitis Carotid artery rupture Pseudoaneurysm formation (carotid) Mediastinitis Necrotizing fasciitis ```

What are 4 vessels that supply Kiesselbach's plexus?

Superior labial artery (septal branch) Anterior ethmoid artery Sphenopalatine artery (septal branch) Greater palatine artery

Where do posterior bleeds occur from?

posterolateral branch of sphenopalatine artery | or carotid artery branches

What percentage of neck masses are neoplastic in adults? | What percentage of neck masses are benign in children?

80% of nonthyroid neck masses are neoplastic, 80% are malignant 80% of neck masses in children are benign

What are 3 categories of neck masses?

congenital infectious neoplastic

List 5 congenital neck masses

``` branchial cleft cyst thyroglossal duct cyst laryngocele ranula teratoma dermoid cyst thymic cyst vascular malformation/tumor ```

List 5 congenital neck masses

``` branchial cleft cyst thyroglossal duct cyst laryngocele ranula teratoma dermoid cyst thymic cyst vascular malformation/tumor cystic hygroma ```

List 5 infectious causes of neck masses

``` reactive viral lymphadenopathy suppurative bacterial lymphadenopathy cat scratch disease HIV infection (primary) Brucellosis Parasitic lymphadenopathy ```

What are 3 concerning histories for undiagnosed head and neck malignancy?

1. unilateral recurrent epistaxis or discharge 2. persistent unilateral otitis media with effusion 3. hoarseness > 2 weeks (Needs ENT referral and quad scope)

List 5 neoplastic causes of neck masses

``` metastatic head and neck cancer thyroid neoplasms salivary gland neoplasms paraganglioma (ie. carotid body tumor) schwannoma lymphoma lipomas, benign skin cysts ```

What are infectious indications for tonsillectomy?

Recurrent tonsillitis (Group A Strep) >/= 7 episodes in 1 year >/= 5 episodes yearly x 2 years >/= 3 episodes yearly x 3 years

What are 5 otologic complications of AOM?

``` chronic middle ear effusion hearing loss speech delay TM perforation cholesteatoma labrynthitis facial nerve palsy ```

What are 5 risk factors for acute otitis media?

``` age (6-18 months) daycare attendance tobacco smoking in the house family history lack of breastfeeding facial abnormalities (ie. cleft palate) ```

What are the diagnostic criteria for acute otitis media?

1. Signs and symptoms of middle ear inflammation (ie. bulging of the tympanic membrane, distinct erythema of the tympanic membrane or otalgia, fever) AND 2. Middle ear effusion (ie. tympanic membrane opacity, decreased or absent tympanic membrane mobility, an air-fluid level, or otorrhea)

What are the two salivary ducts in the neck?

``` Parotid = Stenson's duct Submandibular = Warton's duct ```

What are 5 extra-otologic complications of acute otitis media?

``` mastoiditis meningitis extradural abscess subdural abscess focal otic encephalitis brain abscess lateral venous sinus thrombosis ```

What are the 5 facial sinuses?

``` maxillary ethmoid sphenoid frontal mastoid ```

What is the medical treatment for acute parotitis?

massage analgesia/antibiotics if bacterial sialogogues heat

What size salivary stones can usually pass without surgical intervention?

What is the diagnostic imaging modality of choice in salivary stones?

CT** | U/S is 90% sensitive for stones >2 mm

What is the diagnostic imaging modality of choice in salivary stones?

CT** | U/S is 90% sensitive for stones >2 mm

What are 8 deep spaces in the neck (potential for infectiou)

``` submandibular parotid peritonsillar parapharyngeal retropharyngeal pretracheal prevertebral danger space ```

What are 4 risk factors for suppurative parotitis?

elderly debilitated dehydrated (poor intake, diuretics) dry mouth (anticholinergic, sjogren's, radiation, chemo)

What are the 5 branches of the facial nerve?

``` temporal buccal maxillary mandibular cervical ```