ENT Flashcards
What are 4 risk factors for head and neck cancer?
- smoking
- alcohol use
- HPV infection
- EBV infection
What are 5 diagnostic considerations in the ddx of peritonsillar abscess
peritonsillar cellulitis epiglottitis retropharyngeal cellulitis/abscess parapharyngeal space cellulitis/abscess severe tonsillarpharyngitis
What are 5 ddx considerations in otitis externa?
otomycosis contact dermatitis psoriasis carcinoma of the ear canal chronic suppurative otitis media
What is the nonoperative management strategy for parotitis?
MASH acronym Massage Analgesia +/- antibiotics Sialogogues Heat
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
What is the definition of chronic rhinosinusitis?
Inflammation of the nasal passages and paranasal sinuses >12 weeks
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
What are the 4 facial sinuses?
Frontal
Sphenoid
Ethmoid
Maxillary
What are the 2 mainstays of medical treatment in chronic rhinosinusitis?
nasal saline rinses
intranasal steroid sprays
What is the definition of sudden sensorineural hearing loss?
acute (30 db in 3 different frequencies, idiopathic
often associated with tinnitus, vertigo
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
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
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
What is an alternative to the Weber test?
Hum test
If sound lateralizes to affected side = conductive loss
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
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
What 3 systems contribute to balance equilibrium
Visual
Proprioception
Vestibular
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
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
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?
- unilateral recurrent epistaxis or discharge
- persistent unilateral otitis media with effusion
- 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?
- Signs and symptoms of middle ear inflammation (ie. bulging of the tympanic membrane, distinct erythema of the tympanic membrane or otalgia, fever) AND
- 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
