ENT Flashcards
fever, ear pain (otalgia), ear pressure, hearing impairment,
Cause?
Treatment?
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
What can occur if not treated otitis media?
mastoiditis
-spiking fever and postaruicaular pain, erythema, fluctuant painful mass
IV abx, myringotomy
names for chronic otitis media?
otitis media with effusion
serious otitis media
perforated tympanic membrane and chronic ear discharge
- inflammation for >3 months
- audiogram with tympanometry = conductive hearing loss
Treatment?
chronic otitis media
Treatment = myringotomy with ventilation tube insertion if fluid is persistent or hearing loss
patient was recently on a flight or scuba diving, now having ear pain, hearing loss
barotrauma
- unable to increase middle ear pressures
- can lead to rupture of TM (bloody otorrhea)
Treatment for barotrauma?
- supportive (swallowing, yawning)
- analgesics
- anti-inflammatories
- decongestants
What can cause a Tympanic Membrane Perforation?
- infection (acute otitis media)
2. trauma (barotrauma, direct impact, explosion)
Treatment for TM perforation?
- most heal spontaneously in 2-4 weeks
- avoid water/moisture to ear
- if persistent perforation = tympanoplasty
- if underlying infection = PO ABX
Which class of ABX are not ototoxic?
fluoroquinolones
unilateral hearing loss and otorrhea, long-term retraction of eardrum “pocket in attic” (superior posterior quadrant of TM)
diagnosis? treatment?
cholesteatoma
diagnosis: physical and confirm on CT, audiogram (evaluate hearing loss)
Treatment: surgery
What is the function of the Eustachian Tube?
protects, regulates, clearing the middle ear from nasopharyngeal secretions
-lengthen and become firm by about age 7
What is dysfunction of the eustachian tube?
-diagnose?
primary cause of both acute otitis media and otitis media with effusion
- influenced by anatomy, genetics, immunologic factors
- diagnose = tympanogram
S/S of foreign body in the ear? Diagnose? Treatment?
hearing loss, pain, TM perforation
- diagnose on H/P
- treatment = remove = direct visualization
What are 2 types of hearing loss?
Conductive
Sensorinueural
Examples of conductive hearing loss?
cerumen impaction, exudate from otitis external, infection, otosclerosis
Examples of sensorineural hearing loss?
presbycus, miner disease, acoustic neuroma, disease (lyme, syphilis), congenital
weber results to lateralization of affected ear
conductive loss
weber results to lateralizaton to the better hearing or unaffected side
sensorineural
Rinne for conductive loss
bone >air
Rinne for sensorineural loss
air>bone
most common cause of sensorineural hearing loss?
presbycusis (genetic, age)
-impairment of higher sound frequencies
endolymphatic hydrops?
Meniere Disease
recurrent vertigo, low range hearing loss, tinnitus, one-sided aural pressure
symptoms are related to distention of the inner ear’s endolymphatic compartment
Meniere Disease
Tx: low-sodium diet, diuretics (acetazolamide)
otosclerosis
abnormal bony growth of middle ear (conductive hearing loss)
vestibular schwannoma
acoustic neuroma
unilateral hearing loss, vertigo, intracranial benign tumor on CN 8
Diagnose? TX?
acoustic neuroma
diagnose: MRI
Tx: surgery or radiation
Drug-induced hearing loss causes? (ototoxic) - 3
- aminoglycosides (tobramycin, streptomycin, gentamicin)
- loop diuretics
- anti-cancer (cisplatin)
Congenital causes of hearing loss?
asphyxia, erythroblastosis, maternal rubella
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)
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
swimmer’s ear
otitis externa
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
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
high-pitched ringing, buzzing, roaring, chirping, whistling, hissing?
tinnitus
what is 90% of chronic tinnitus associated with?
sensorineural hearing loss
Causes: loud noise, presbycusis, medicaiton, meniere disease, acoustic disease
What medications can cause tinnitus?
- NSAID
- ABX - aminoglycoside, erythromycin, fluoroquinolone, tetracycline, vancyomycin, chloroquine
- antidepressants - benzo, TCA, balproate, sertraline
- HTN - loop diuretics, CCB
- oncology - ciplastin, methotrexate
sensation of movement (spinning, tumbling, falling) in the absence of any actual movement or an over-response to movement
vertigo
peripheral causes of vestibular dysfunction are???
labyrinthitis, benign paroxysmal positional vertigo, endolymphatic hydrops (meniere syndrome), vestibular neuritis, head injury
What type of vertigo = sudden onset, n/v, tinnitus, hearing loss, horizontal nystagmus
peripheral vertigo (tinnitus)
What type of vertigo = gradual onset, vertical nystagmus, no auditory symptoms
-dysarthria, dysphagia, focal weakness
central vertigo (commonly associated with motor, sensory, cerebellar deficits)
Dix-hallpike maneuver is diagnosis for what?
benign positional vertigo
romberg
central vertigo
To treat vertigo symptomatically?
meclizine
vertebral basilar insufficiency?
compression of vertebral artery
4 D’s = dizzy, diplopia, dysphagia, drop attacks
another name for the Dix-hallpike maneuver?
Nylen-Barany test
Treatment for Benign positional vertigo?
Epley maneuver, meclizine
What is the Triad for Meniere’s Disease?
- low frequency hearing loss
- tinnitus with aural fullness
- vertigo
vertigo with hearing loss, n/v, no fever or pain, middle ear infection
labyrinthitis
(inflammation of vestibular labyrinth)
-self limiting
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
What ear problem should you think of with neurofibromatosis?
acoustic neuroma
unilateral hearing loss +/- vertigo?
acoustic neuroma
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
gold standard for sinusitis?
CT
Treatment for sinusitis?
first line = amoxicillin
-NSAID = pain, saline washes, steam, decongestants, intranasal corticosteroids
=augmentin is another good first choice
Treatment for sinusitis?
first line = amoxicillin
-NSAID = pain, saline washes, steam, decongestants, intranasal corticosteroids
=augmentin is another good first choice
Allergic Rhinitis?
IgE
other atopic disease = asthma, eczema, atopic dermatitis, FHx
vasomotor rhinitis
rhinorrhea caused by increased secretion of mucus from nasal mucosa
rhinitis medicamentosa?
caused by overzealous use of decongestant drops or spray (rebound congestion)
allergic shiner, rhinorrhea, itchy/watery eye, sneezing, congestion, dry cough, pale, boggy, blue turbinates
allergic rhinitis
Tx: avoid known allergens, antihistamine, nasal steroid
what area of the nose is most common for epistaxis?
kiesselbach plexus (anterior)
what is posterior nose bleed and treatment?
woodruff plexus, HTN, and atherosclerosis
Tx: packing is more difficult = need specialist evaluation and input monitoring
Treatment for anterior nose bleed?
- direct pressure - sitting position and leaning forward
- chemical cauterization
- packing
persistent foul smelling purulent unilateral nasal discharge in a kid
nasal foreign body
teardrop-shaped growth in nose or sinus, grape-like appearance
nasal polyp
What is Samter triad?
nasal polyp and asthma = don’t give aspirin b/c will cause severe bronchospasm
Treat nasal polyp?
- 3 month trial of topical nasal corticosteroid
- surgery
- eliminate or reduce irritants (allergies)
most common cause of a sore throat?
streptococcus pyogenes (group A strep)
What ist he Centor Criteria?
Streptoccous pyogenes (group A strep) -fever, absence of cough, tonsillar exudates, tender cervical lymphadenopathy
Is coryza, hoarseness, cough suggestive of streptococcal pharyngitis?
NO
What is a screening test for strept throat? confirmatory test?
Screen: rapid streptocci screening
confirm: throat culture
Treatment for strept throat?
-IM penicillin
-PO penicillin or -cefuroxime
(allergy = erythromycin)
What do you suspect with - arthritis, carditis, sydenham chorea, erythema marginatum, subcutaneous nodules?
rheumatic fever
-order ASO Titers
pharyngitis with progressive growth of grey-white membrane?
diphtheria
Tx: antitoxin, erythromycin, pen G
Quincy abscess
peritonsillar abscess
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
Triad = fever, lymphadenopathy, pharyngitis, diffuse cervical lymphadenitis
rash with PCN
infectious mononucleosis
-caused by epstein-barr virus
-splenomegaly = no contact sports
child, severe sore throat, drooling, inspiratory stridor, sore through, tripoding
xray = thumb print
epiglottis
(don’t use instruments to view airway = may cause obstruction
Treatment for epiglottis?
- admit
- IV ABX, IV corticosteroids
- oxygen
etiology of laryngitis
viral, follows URI
hallmark = hoarseness
laryngitis
just supportive care
sialoadenitis
-parotitis (parotid gland affected)
-bacterial
-inflammation of salivary gland
-staph aureus
Tx: cephalosporin
sialolithiasis
- mechanical obstruction (salivary stone)
- submandibular most common
- Treatment: cephalosporin, remove stone
What causes mumps?
paramyxovirus
how do you confirm mumps?
- hemagglutination inhibition
- complement fixation
- elevated serum salivary type amylase
Treat mumps?
- self limiting
- hydration and rest
what class of drugs commonly cause gingival hyperplasia?
calcium channel blockers
single/multiple painful, round ulcers with yellow-gray center and red halo
aphthous ulcer (canker sore, ulcerative stomatitis)
white plaque-like oral lesion that does not scrape off
oral leukoplakia (precancerous)
white plaque-like oral lesion that bleeds when scraped, erythematous base
oral candidiasis
(KOH for diagnosis)
-yeast
Risk factor for oral candidiasis?
dentures, DM, immunocompromised, chemo/radiation, corticosteroid or ABX treatment
Treatment for oral candidiasis?
antifungal (ketoconazole, fluconaole, nystatin rinse)
oral herpes simplex?
diagnose with Tzank smear or viral culture
- treatment topical acyclovir
- PO valacyclovir
Trismus?
(locked jaw) associated with tetanus
What is ludwig angina?
midline “woody” submadnibular tenderness/infection
trismus, stiff neck, risus sadonicus (retracted smile), rigid abdomen,
tetanus
Tetanus treatment?
- tetanus immune globulin
- wound debridement
- metronidazole or pen G
most common thyroid neoplasm?
papillary
risk factors for thyroid gland neoplasm?
radiation, goiter, FHx, asian
cyst appears after URI anterior to the SCM, most common lateral neck mass?
branchial cleft cyst
-excision!
hyoid mass that rises with tongue protrusion, most common midline neck mass?
thyroglossal duct cyst
-excision
bilateral lymphadenopathy with fever, upper respiratory signs
think infection
unilateral lymphadneopathy, painless, persistent
think hodgkin lymphoma (reed sternberg)
prominent posterior cervical lymphadenopathy
rubella
generalized LAD
HIV, malignancy
-inguinal = STD
Virchow’s node?
left supraclavicular node = GI cancer
