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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
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2
Q

What can occur if not treated otitis media?

A

mastoiditis
-spiking fever and postaruicaular pain, erythema, fluctuant painful mass

IV abx, myringotomy

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3
Q

names for chronic otitis media?

A

otitis media with effusion

serious otitis media

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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

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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)
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6
Q

Treatment for barotrauma?

A
  • supportive (swallowing, yawning)
  • analgesics
  • anti-inflammatories
  • decongestants
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7
Q

What can cause a Tympanic Membrane Perforation?

A
  1. infection (acute otitis media)

2. trauma (barotrauma, direct impact, explosion)

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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
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9
Q

Which class of ABX are not ototoxic?

A

fluoroquinolones

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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

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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

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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
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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
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14
Q

What are 2 types of hearing loss?

A

Conductive

Sensorinueural

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15
Q

Examples of conductive hearing loss?

A

cerumen impaction, exudate from otitis external, infection, otosclerosis

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16
Q

Examples of sensorineural hearing loss?

A

presbycus, miner disease, acoustic neuroma, disease (lyme, syphilis), congenital

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17
Q

weber results to lateralization of affected ear

A

conductive loss

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18
Q

weber results to lateralizaton to the better hearing or unaffected side

A

sensorineural

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19
Q

Rinne for conductive loss

A

bone >air

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20
Q

Rinne for sensorineural loss

A

air>bone

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21
Q

most common cause of sensorineural hearing loss?

A

presbycusis (genetic, age)

-impairment of higher sound frequencies

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22
Q

endolymphatic hydrops?

A

Meniere Disease

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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)

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24
Q

otosclerosis

A

abnormal bony growth of middle ear (conductive hearing loss)

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25
Q

vestibular schwannoma

A

acoustic neuroma

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26
Q

unilateral hearing loss, vertigo, intracranial benign tumor on CN 8

Diagnose? TX?

A

acoustic neuroma

diagnose: MRI
Tx: surgery or radiation

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27
Q

Drug-induced hearing loss causes? (ototoxic) - 3

A
  1. aminoglycosides (tobramycin, streptomycin, gentamicin)
  2. loop diuretics
  3. anti-cancer (cisplatin)
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28
Q

Congenital causes of hearing loss?

A

asphyxia, erythroblastosis, maternal rubella

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29
Q

auricular pain and edema, patient is a wrestler - had direct trauma to anterior auricle…. tx?

A

hematoma of external ear

Tx: evacuate blood (may lead to thickening of cartilage or cauliflower ear)

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30
Q

fever, pain, bulging mastoid, ear protrusion, mastoid pain on percussion

Diagnosis? cause? treatment?

A

otomastoiditis
(infection of mastoid - strep pneumo)

Tx: drainage of middle ear fluid with ventilation tubes or mastoidectomy and IV ABX

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31
Q

swimmer’s ear

A

otitis externa

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32
Q

ear pain (when moving tragus/auricle), red, swollen ear canal, purulent exudate

diagnosis? cause? treatment?

A
  • otitis externa
  • pseudomonas, proteus, fungi
  • antibiotic drops (fluoroquinolone +/- corticosteroid), avoid further moisture or ear injury
    ex. cipro, levo, moxi
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33
Q

what is necrotizing infection extending into the blood vessels, bone, and cartilage in DM or immunocompromised patients?

A

malignant otitis externa

-need hospitalization and IV ABX

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34
Q

high-pitched ringing, buzzing, roaring, chirping, whistling, hissing?

A

tinnitus

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35
Q

what is 90% of chronic tinnitus associated with?

A

sensorineural hearing loss

Causes: loud noise, presbycusis, medicaiton, meniere disease, acoustic disease

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36
Q

What medications can cause tinnitus?

A
  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
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37
Q

sensation of movement (spinning, tumbling, falling) in the absence of any actual movement or an over-response to movement

A

vertigo

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38
Q

peripheral causes of vestibular dysfunction are???

A

labyrinthitis, benign paroxysmal positional vertigo, endolymphatic hydrops (meniere syndrome), vestibular neuritis, head injury

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39
Q

What type of vertigo = sudden onset, n/v, tinnitus, hearing loss, horizontal nystagmus

A

peripheral vertigo (tinnitus)

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40
Q

What type of vertigo = gradual onset, vertical nystagmus, no auditory symptoms
-dysarthria, dysphagia, focal weakness

A 
central vertigo 
(commonly associated with motor, sensory, cerebellar deficits)
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41
Q

Dix-hallpike maneuver is diagnosis for what?

A

benign positional vertigo

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42
Q

romberg

A

central vertigo

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43
Q

To treat vertigo symptomatically?

A

meclizine

44
Q

vertebral basilar insufficiency?

A

compression of vertebral artery

4 D’s = dizzy, diplopia, dysphagia, drop attacks

45
Q

another name for the Dix-hallpike maneuver?

A

Nylen-Barany test

46
Q

Treatment for Benign positional vertigo?

A

Epley maneuver, meclizine

47
Q

What is the Triad for Meniere’s Disease?

A
  1. low frequency hearing loss
  2. tinnitus with aural fullness
  3. vertigo
48
Q

vertigo with hearing loss, n/v, no fever or pain, middle ear infection

A

labyrinthitis
(inflammation of vestibular labyrinth)
-self limiting

49
Q

Vestibular Neuronitis?

A

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
Q

What ear problem should you think of with neurofibromatosis?

A

acoustic neuroma

51
Q

unilateral hearing loss +/- vertigo?

A

acoustic neuroma

52
Q

purulent nasal discharge, facial pain/pressure, nasal obstruction or congestion, fever, follows a URI

-tenderness over sinus

A

acute sinusitis

strept pneumo, H influ, Saph aureus, m Cat - same as otitis media

53
Q

gold standard for sinusitis?

A

CT

54
Q

Treatment for sinusitis?

A

first line = amoxicillin
-NSAID = pain, saline washes, steam, decongestants, intranasal corticosteroids

=augmentin is another good first choice

55
Q

Treatment for sinusitis?

A

first line = amoxicillin
-NSAID = pain, saline washes, steam, decongestants, intranasal corticosteroids

=augmentin is another good first choice

56
Q

Allergic Rhinitis?

A

IgE

other atopic disease = asthma, eczema, atopic dermatitis, FHx

57
Q

vasomotor rhinitis

A

rhinorrhea caused by increased secretion of mucus from nasal mucosa

58
Q

rhinitis medicamentosa?

A

caused by overzealous use of decongestant drops or spray (rebound congestion)

59
Q

allergic shiner, rhinorrhea, itchy/watery eye, sneezing, congestion, dry cough, pale, boggy, blue turbinates

A

allergic rhinitis

Tx: avoid known allergens, antihistamine, nasal steroid

60
Q

what area of the nose is most common for epistaxis?

A

kiesselbach plexus (anterior)

61
Q

what is posterior nose bleed and treatment?

A

woodruff plexus, HTN, and atherosclerosis

Tx: packing is more difficult = need specialist evaluation and input monitoring

62
Q

Treatment for anterior nose bleed?

A
  1. direct pressure - sitting position and leaning forward
  2. chemical cauterization
  3. packing
63
Q

persistent foul smelling purulent unilateral nasal discharge in a kid

A

nasal foreign body

64
Q

teardrop-shaped growth in nose or sinus, grape-like appearance

A

nasal polyp

65
Q

What is Samter triad?

A

nasal polyp and asthma = don’t give aspirin b/c will cause severe bronchospasm

66
Q

Treat nasal polyp?

A
  • 3 month trial of topical nasal corticosteroid
  • surgery
  • eliminate or reduce irritants (allergies)
67
Q

most common cause of a sore throat?

A

streptococcus pyogenes (group A strep)

68
Q

What ist he Centor Criteria?

A 
Streptoccous pyogenes (group A strep)
-fever, absence of cough, tonsillar exudates, tender cervical lymphadenopathy
69
Q

Is coryza, hoarseness, cough suggestive of streptococcal pharyngitis?

A

NO

70
Q

What is a screening test for strept throat? confirmatory test?

A

Screen: rapid streptocci screening
confirm: throat culture

71
Q

Treatment for strept throat?

A

-IM penicillin
-PO penicillin or -cefuroxime
(allergy = erythromycin)

72
Q

What do you suspect with - arthritis, carditis, sydenham chorea, erythema marginatum, subcutaneous nodules?

A

rheumatic fever

-order ASO Titers

73
Q

pharyngitis with progressive growth of grey-white membrane?

A

diphtheria

Tx: antitoxin, erythromycin, pen G

74
Q

Quincy abscess

A

peritonsillar abscess

75
Q

drooling, hot potato voice, fever, ear pain

  • deviation of uvula
  • adult

Treatment?

A

Peritonsillar abscess

Tx: monitor airway, immediate drainage (I&D), IV unasyn or clinda, can use amoxicillin

76
Q

Triad = fever, lymphadenopathy, pharyngitis, diffuse cervical lymphadenitis

rash with PCN

A

infectious mononucleosis
-caused by epstein-barr virus

-splenomegaly = no contact sports

77
Q

child, severe sore throat, drooling, inspiratory stridor, sore through, tripoding

xray = thumb print

A

epiglottis

(don’t use instruments to view airway = may cause obstruction

78
Q

Treatment for epiglottis?

A
  • admit
  • IV ABX, IV corticosteroids
  • oxygen
79
Q

etiology of laryngitis

A

viral, follows URI

80
Q

hallmark = hoarseness

A

laryngitis

just supportive care

81
Q

sialoadenitis

A

-parotitis (parotid gland affected)
-bacterial
-inflammation of salivary gland
-staph aureus
Tx: cephalosporin

82
Q

sialolithiasis

A
  • mechanical obstruction (salivary stone)
  • submandibular most common
  • Treatment: cephalosporin, remove stone
83
Q

What causes mumps?

A

paramyxovirus

84
Q

how do you confirm mumps?

A
  • hemagglutination inhibition
  • complement fixation
  • elevated serum salivary type amylase
85
Q

Treat mumps?

A
  • self limiting

- hydration and rest

86
Q

what class of drugs commonly cause gingival hyperplasia?

A

calcium channel blockers

87
Q

single/multiple painful, round ulcers with yellow-gray center and red halo

A

aphthous ulcer (canker sore, ulcerative stomatitis)

88
Q

white plaque-like oral lesion that does not scrape off

A

oral leukoplakia (precancerous)

89
Q

white plaque-like oral lesion that bleeds when scraped, erythematous base

A

oral candidiasis
(KOH for diagnosis)
-yeast

90
Q

Risk factor for oral candidiasis?

A

dentures, DM, immunocompromised, chemo/radiation, corticosteroid or ABX treatment

91
Q

Treatment for oral candidiasis?

A

antifungal (ketoconazole, fluconaole, nystatin rinse)

92
Q

oral herpes simplex?

A

diagnose with Tzank smear or viral culture

  • treatment topical acyclovir
  • PO valacyclovir
93
Q

Trismus?

A

(locked jaw) associated with tetanus

94
Q

What is ludwig angina?

A

midline “woody” submadnibular tenderness/infection

95
Q

trismus, stiff neck, risus sadonicus (retracted smile), rigid abdomen,

A

tetanus

96
Q

Tetanus treatment?

A
  • tetanus immune globulin
  • wound debridement
  • metronidazole or pen G
97
Q

most common thyroid neoplasm?

A

papillary

98
Q

risk factors for thyroid gland neoplasm?

A

radiation, goiter, FHx, asian

99
Q

cyst appears after URI anterior to the SCM, most common lateral neck mass?

A

branchial cleft cyst

-excision!

100
Q

hyoid mass that rises with tongue protrusion, most common midline neck mass?

A

thyroglossal duct cyst

-excision

101
Q

bilateral lymphadenopathy with fever, upper respiratory signs

A

think infection

102
Q

unilateral lymphadneopathy, painless, persistent

A

think hodgkin lymphoma (reed sternberg)

103
Q

prominent posterior cervical lymphadenopathy

A

rubella

104
Q

generalized LAD

A

HIV, malignancy

-inguinal = STD

105
Q

Virchow’s node?

A

left supraclavicular node = GI cancer

PANCE (16 decks)

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