ENT Flashcards
1
Q
fever, ear pain (otalgia), ear pressure, hearing impairment,
Cause?
Treatment?
A
acute otitis media
Cause = viral (most common and RSV),
bacterial (strep pneuma, h influx, m cat)
Treatment = ABX = amoxicillin
- remove risk factors (day care, 2nd hand smoke)
- watchful waiting (if older kid no pain or fever)
- myringotomy and tympanostomy = recurring case
2
Q
What can occur if not treated otitis media?
A
mastoiditis
-spiking fever and postaruicaular pain, erythema, fluctuant painful mass
IV abx, myringotomy
3
Q
names for chronic otitis media?
A
otitis media with effusion
serious otitis media
4
Q
perforated tympanic membrane and chronic ear discharge
- inflammation for >3 months
- audiogram with tympanometry = conductive hearing loss
Treatment?
A
chronic otitis media
Treatment = myringotomy with ventilation tube insertion if fluid is persistent or hearing loss
5
Q
patient was recently on a flight or scuba diving, now having ear pain, hearing loss
A
barotrauma
- unable to increase middle ear pressures
- can lead to rupture of TM (bloody otorrhea)
6
Q
Treatment for barotrauma?
A
- supportive (swallowing, yawning)
- analgesics
- anti-inflammatories
- decongestants
7
Q
What can cause a Tympanic Membrane Perforation?
A
- infection (acute otitis media)
2. trauma (barotrauma, direct impact, explosion)
8
Q
Treatment for TM perforation?
A
- most heal spontaneously in 2-4 weeks
- avoid water/moisture to ear
- if persistent perforation = tympanoplasty
- if underlying infection = PO ABX
9
Q
Which class of ABX are not ototoxic?
A
fluoroquinolones
10
Q
unilateral hearing loss and otorrhea, long-term retraction of eardrum “pocket in attic” (superior posterior quadrant of TM)
diagnosis? treatment?
A
cholesteatoma
diagnosis: physical and confirm on CT, audiogram (evaluate hearing loss)
Treatment: surgery
11
Q
What is the function of the Eustachian Tube?
A
protects, regulates, clearing the middle ear from nasopharyngeal secretions
-lengthen and become firm by about age 7
12
Q
What is dysfunction of the eustachian tube?
-diagnose?
A
primary cause of both acute otitis media and otitis media with effusion
- influenced by anatomy, genetics, immunologic factors
- diagnose = tympanogram
13
Q
S/S of foreign body in the ear? Diagnose? Treatment?
A
hearing loss, pain, TM perforation
- diagnose on H/P
- treatment = remove = direct visualization
14
Q
What are 2 types of hearing loss?
A
Conductive
Sensorinueural
15
Q
Examples of conductive hearing loss?
A
cerumen impaction, exudate from otitis external, infection, otosclerosis
16
Q
Examples of sensorineural hearing loss?
A
presbycus, miner disease, acoustic neuroma, disease (lyme, syphilis), congenital
17
Q
weber results to lateralization of affected ear
A
conductive loss
18
Q
weber results to lateralizaton to the better hearing or unaffected side
A
sensorineural
19
Q
Rinne for conductive loss
A
bone >air
20
Q
Rinne for sensorineural loss
A
air>bone
21
Q
most common cause of sensorineural hearing loss?
A
presbycusis (genetic, age)
-impairment of higher sound frequencies
22
Q
endolymphatic hydrops?
A
Meniere Disease
23
Q
recurrent vertigo, low range hearing loss, tinnitus, one-sided aural pressure
symptoms are related to distention of the inner ear’s endolymphatic compartment
A
Meniere Disease
Tx: low-sodium diet, diuretics (acetazolamide)
24
Q
otosclerosis
A
abnormal bony growth of middle ear (conductive hearing loss)
25
vestibular schwannoma
acoustic neuroma
26
unilateral hearing loss, vertigo, intracranial benign tumor on CN 8
Diagnose? TX?
acoustic neuroma
diagnose: MRI
Tx: surgery or radiation
27
Drug-induced hearing loss causes? (ototoxic) - 3
1. aminoglycosides (tobramycin, streptomycin, gentamicin)
2. loop diuretics
3. anti-cancer (cisplatin)
28
Congenital causes of hearing loss?
asphyxia, erythroblastosis, maternal rubella
29
auricular pain and edema, patient is a wrestler - had direct trauma to anterior auricle.... tx?
hematoma of external ear
Tx: evacuate blood (may lead to thickening of cartilage or cauliflower ear)
30
fever, pain, bulging mastoid, ear protrusion, mastoid pain on percussion
Diagnosis? cause? treatment?
otomastoiditis
(infection of mastoid - strep pneumo)
Tx: drainage of middle ear fluid with ventilation tubes or mastoidectomy and IV ABX
31
swimmer's ear
otitis externa
32
ear pain (when moving tragus/auricle), red, swollen ear canal, purulent exudate
diagnosis? cause? treatment?
- otitis externa
- pseudomonas, proteus, fungi
- antibiotic drops (fluoroquinolone +/- corticosteroid), avoid further moisture or ear injury
ex. cipro, levo, moxi
33
what is necrotizing infection extending into the blood vessels, bone, and cartilage in DM or immunocompromised patients?
malignant otitis externa
-need hospitalization and IV ABX
34
high-pitched ringing, buzzing, roaring, chirping, whistling, hissing?
tinnitus
35
what is 90% of chronic tinnitus associated with?
sensorineural hearing loss
Causes: loud noise, presbycusis, medicaiton, meniere disease, acoustic disease
36
What medications can cause tinnitus?
1. NSAID
2. ABX - aminoglycoside, erythromycin, fluoroquinolone, tetracycline, vancyomycin, chloroquine
3. antidepressants - benzo, TCA, balproate, sertraline
4. HTN - loop diuretics, CCB
5. oncology - ciplastin, methotrexate
37
sensation of movement (spinning, tumbling, falling) in the absence of any actual movement or an over-response to movement
vertigo
38
peripheral causes of vestibular dysfunction are???
labyrinthitis, benign paroxysmal positional vertigo, endolymphatic hydrops (meniere syndrome), vestibular neuritis, head injury
39
What type of vertigo = sudden onset, n/v, tinnitus, hearing loss, horizontal nystagmus
peripheral vertigo (tinnitus)
40
What type of vertigo = gradual onset, vertical nystagmus, no auditory symptoms
-dysarthria, dysphagia, focal weakness
```
central vertigo
(commonly associated with motor, sensory, cerebellar deficits)
```
41
Dix-hallpike maneuver is diagnosis for what?
benign positional vertigo
42
romberg
central vertigo
43
To treat vertigo symptomatically?
meclizine
44
vertebral basilar insufficiency?
compression of vertebral artery
| 4 D's = dizzy, diplopia, dysphagia, drop attacks
45
another name for the Dix-hallpike maneuver?
Nylen-Barany test
46
Treatment for Benign positional vertigo?
Epley maneuver, meclizine
47
What is the Triad for Meniere's Disease?
1. low frequency hearing loss
2. tinnitus with aural fullness
3. vertigo
48
vertigo with hearing loss, n/v, no fever or pain, middle ear infection
labyrinthitis
(inflammation of vestibular labyrinth)
-self limiting
49
Vestibular Neuronitis?
acute, sustained dysfunction of the peripheral vestibular system with n/v, vertigo
-not labyrinthitis = b/c does not affect hearing and normal caloric test
50
What ear problem should you think of with neurofibromatosis?
acoustic neuroma
51
unilateral hearing loss +/- vertigo?
acoustic neuroma
52
purulent nasal discharge, facial pain/pressure, nasal obstruction or congestion, fever, follows a URI
-tenderness over sinus
acute sinusitis
| strept pneumo, H influ, Saph aureus, m Cat - same as otitis media
53
gold standard for sinusitis?
CT
54
Treatment for sinusitis?
first line = amoxicillin
-NSAID = pain, saline washes, steam, decongestants, intranasal corticosteroids
=augmentin is another good first choice
55
Treatment for sinusitis?
first line = amoxicillin
-NSAID = pain, saline washes, steam, decongestants, intranasal corticosteroids
=augmentin is another good first choice
56
Allergic Rhinitis?
IgE
| other atopic disease = asthma, eczema, atopic dermatitis, FHx
57
vasomotor rhinitis
rhinorrhea caused by increased secretion of mucus from nasal mucosa
58
rhinitis medicamentosa?
caused by overzealous use of decongestant drops or spray (rebound congestion)
59
allergic shiner, rhinorrhea, itchy/watery eye, sneezing, congestion, dry cough, pale, boggy, blue turbinates
allergic rhinitis
Tx: avoid known allergens, antihistamine, nasal steroid
60
what area of the nose is most common for epistaxis?
kiesselbach plexus (anterior)
61
what is posterior nose bleed and treatment?
woodruff plexus, HTN, and atherosclerosis
Tx: packing is more difficult = need specialist evaluation and input monitoring
62
Treatment for anterior nose bleed?
1. direct pressure - sitting position and leaning forward
2. chemical cauterization
3. packing
63
persistent foul smelling purulent unilateral nasal discharge in a kid
nasal foreign body
64
teardrop-shaped growth in nose or sinus, grape-like appearance
nasal polyp
65
What is Samter triad?
nasal polyp and asthma = don't give aspirin b/c will cause severe bronchospasm
66
Treat nasal polyp?
- 3 month trial of topical nasal corticosteroid
- surgery
- eliminate or reduce irritants (allergies)
67
most common cause of a sore throat?
streptococcus pyogenes (group A strep)
68
What ist he Centor Criteria?
```
Streptoccous pyogenes (group A strep)
-fever, absence of cough, tonsillar exudates, tender cervical lymphadenopathy
```
69
Is coryza, hoarseness, cough suggestive of streptococcal pharyngitis?
NO
70
What is a screening test for strept throat? confirmatory test?
Screen: rapid streptocci screening
confirm: throat culture
71
Treatment for strept throat?
-IM penicillin
-PO penicillin or -cefuroxime
(allergy = erythromycin)
72
What do you suspect with - arthritis, carditis, sydenham chorea, erythema marginatum, subcutaneous nodules?
rheumatic fever
| -order ASO Titers
73
pharyngitis with progressive growth of grey-white membrane?
diphtheria
Tx: antitoxin, erythromycin, pen G
74
Quincy abscess
peritonsillar abscess
75
drooling, hot potato voice, fever, ear pain
- deviation of uvula
- adult
Treatment?
Peritonsillar abscess
Tx: monitor airway, immediate drainage (I&D), IV unasyn or clinda, can use amoxicillin
76
Triad = fever, lymphadenopathy, pharyngitis, diffuse cervical lymphadenitis
rash with PCN
infectious mononucleosis
-caused by epstein-barr virus
-splenomegaly = no contact sports
77
child, severe sore throat, drooling, inspiratory stridor, sore through, tripoding
xray = thumb print
epiglottis
(don't use instruments to view airway = may cause obstruction
78
Treatment for epiglottis?
- admit
- IV ABX, IV corticosteroids
- oxygen
79
etiology of laryngitis
viral, follows URI
80
hallmark = hoarseness
laryngitis
just supportive care
81
sialoadenitis
-parotitis (parotid gland affected)
-bacterial
-inflammation of salivary gland
-staph aureus
Tx: cephalosporin
82
sialolithiasis
- mechanical obstruction (salivary stone)
- submandibular most common
- Treatment: cephalosporin, remove stone
83
What causes mumps?
paramyxovirus
84
how do you confirm mumps?
- hemagglutination inhibition
- complement fixation
- elevated serum salivary type amylase
85
Treat mumps?
- self limiting
| - hydration and rest
86
what class of drugs commonly cause gingival hyperplasia?
calcium channel blockers
87
single/multiple painful, round ulcers with yellow-gray center and red halo
aphthous ulcer (canker sore, ulcerative stomatitis)
88
white plaque-like oral lesion that does not scrape off
oral leukoplakia (precancerous)
89
white plaque-like oral lesion that bleeds when scraped, erythematous base
oral candidiasis
(KOH for diagnosis)
-yeast
90
Risk factor for oral candidiasis?
dentures, DM, immunocompromised, chemo/radiation, corticosteroid or ABX treatment
91
Treatment for oral candidiasis?
antifungal (ketoconazole, fluconaole, nystatin rinse)
92
oral herpes simplex?
diagnose with Tzank smear or viral culture
- treatment topical acyclovir
- PO valacyclovir
93
Trismus?
(locked jaw) associated with tetanus
94
What is ludwig angina?
midline "woody" submadnibular tenderness/infection
95
trismus, stiff neck, risus sadonicus (retracted smile), rigid abdomen,
tetanus
96
Tetanus treatment?
- tetanus immune globulin
- wound debridement
- metronidazole or pen G
97
most common thyroid neoplasm?
papillary
98
risk factors for thyroid gland neoplasm?
radiation, goiter, FHx, asian
99
cyst appears after URI anterior to the SCM, most common lateral neck mass?
branchial cleft cyst
| -excision!
100
hyoid mass that rises with tongue protrusion, most common midline neck mass?
thyroglossal duct cyst
-excision
101
bilateral lymphadenopathy with fever, upper respiratory signs
think infection
102
unilateral lymphadneopathy, painless, persistent
think hodgkin lymphoma (reed sternberg)
103
prominent posterior cervical lymphadenopathy
rubella
104
generalized LAD
HIV, malignancy
| -inguinal = STD
105
Virchow's node?
left supraclavicular node = GI cancer
