ENT Flashcards
What antibiotics are ototoxic? What are 2 other medications that cause reversible hearing loss ?
Aminoglycosides (gentamicin, tobramycin)
Loop diuretics & salicylate
What is the correct diagnosis and treatment for a 9 y/o male with purulent right ear discharge for several months despite several antibiotics…exam shows retraction of TM and squamous debris?
Cholesteatoma - referral to ENT
What diagnosis should you consider in a patient with foul smelling discharge despite treatment of perforated TM?
Cholestatoma
What is the most common cause of sudden bilateral sensorineural deafness?
Viral labyrinthitis
What are the 4 most common viral causes of sensorineural hearing loss?
CMV
Measles
Mumps
Rubella
What is the most common cause of neonatal hearing loss? How can this be prevented
Bacterial meningitis - can’t prevent despite treatment with antibiotics
What are the two newborn hearing screens and when should this be performed by?
Auditory brainstem response (ABR) and otoacoustic emissions (OAE)
Identification of hearing loss by 3 months with treatment by 6 months
What test is used to detect bilateral hearing loss in infants and toddlers?
Visual reinforcement audiometry (VRA)
What is indicated by a flat line (low amplitude) on tympanogram?
Stiff membrane or middle ear fluid or obstructed tympanostomy tube
How does tympanometry measure hearing sensitivity?
Tympanometry does NOT measure hearing sensitivity (you can have normal tympanogram with sensorineural hearing loss)
What is indicated by a high amplitude line on tympanometry?
Hypermobile TM
What is measured by the area under the tympanogram curve? And what does a high volume of this area indicate?
The area of the external canal - high volume indicates perforated TM
You are presented with a 4 y/o with chronic drainage through left TM, what is the likely cause and how would you treat?
Pseudomonas causing chronic suppurating otitis media
Topical ofloxacin
What diagnosis should you consider in a patient with persistent otitis media despite appropriate antibiotics who presents with headache and vomiting ?
Bacterial meningitis
What diagnosis should you consider in a patient with tympanostomy tubes who presents with copious bloody discharge and large red mass in the ear?
Tympanostomy tube granuloma
What should you do in a patient with swelling and deformity of the external ear after trauma?
Needle aspiration of hematoma
What is the diagnosis and 4 most common cause of postauricular swelling and erythema ?
Mastoiditis - strep pneumoniae, h flu, strep pyogenes and staph aureus
How would you confirm diagnosis of mastoiditis? How would you treat?
CT and tympanocentesis with culture - IV antibiotics and surgery
What 4 things are associated with nasal polyps and what study should you order in a patient with this finding?
Cystic fibrosis Asthma Chronic allergic rhinitis Chronic sinusitis **sweat chloride test**
What diagnosis presents as cyanosis while feeding but resolution with crying? What syndrome is this commonly found in?
Choanal atresia - CHARGE syndrome
Which sinuses are present at birth?
Maxillary and ethmoid
When are the sphenoid and frontal sinuses developed ?
Sphenoid: age 3 - 7 years
Frontal: teen years
What should be done in a patient with fracture of the frontal sinus? Why?
Surgery for repair to avoid CNS infection
When is a CT indicated in the diagnosis of sinusitis?
Only for chronic recurrent sinusitis
You are presented with a 13 y/o make with recurrent epistaxis. Bleeding is increasing in frequency, severity and duration. What is the next step?
CT scan to rule out posterior nasopharyngeal mass such as nasopharyngeal angiofibroma
What clinical finding can differentiate strep pharyngitis from mono?
Only mono presents with hepatosplenomegaly
You are presented with a child with high fever, swollen lymph nodes, pharyngitis and hepatomegaly. Strep is positive. Monospot is negative. What is the next step?
EBV titers
What would you do for a sexually active teenager who presents with sore throat and erythematous patches of the pharynx?
Test for GC pharyngitis and other STD testing
What treatment would you consider for a patient who presents with sore throat and difficulty opening the mouth as well as muffled voice…exam shows swelling around one tonsil and uvula deviation?
Needle aspiration plus ampicillin/sulbactam or clinda or augmentin
What is the cause of hypernasal voice after tonsillectomy / adenoidectomy?
Velopharyngel insufficiency
What would be the next appropriate step for a patient who presents with high fever, difficulty swallowing and neck hyperextended with drooling? What would you expect to find on imaging?
Lateral neck film will show widening of retropharyngeal space and then CT to confirm
What is the appropriate treatment for retropharyngeal abscess?
Surgical emergency – needle aspiration under anesthesia plus clindamycin or unasyn
How would you differentiate retropharyngeal abscess vs epiglottis?
In epiglottitis, children lean forward vs hyperestension of neck which is found in retropharyngeal abscess
What should you do for a patient with ankyloglossia?
No intervention needed
What are the 5 common causes of delayed tooth eruption? After what age is tooth eruption considered delayed?
Hypothyroid Hypopituitarism Ectodermal Hypoplasia Hypohidrosis Rickets *delayed if no teeth by 16 months
How should you transport an avulsed permanent tooth?
In saliva or chilled milk
What diagnosis presents in an infant who sleeps with a water filled pacifier who presents with tender red nodules on the cheek who is afebrile with good PO intake and physical shows plaques and nodules? How would you treat?
Cold induced panniculitis - no treatment needed
What is the gender predisposition em for cleft lip and palate?
Cleft lip/palate is more common in boys but cleft palate alone occurs more frequently in girls
What is the genetic / environmental cause of cleft lip and palate ?
Can occur as single gene defect or in conjunction with other chromosomal abnormalities or from teratogenic exposure
What is the first line treatment for dental abscess? Second line?
Penicillin
Clindamycin or erythromycin (if PCN allergy)
What is the next appropriate step in a patient with croupy cough and X-ray repot of steeple sign?
Look at X-ray to r/o foreign body
What are the 4 common causes of inspiratory stridor?
Paralyzed vocal cords
Adenoid/tonsil enlargement
Laryngomalacia
Pharyngeal or hypopharyngeal mass
What is the most common cause of congenital stridor ?
Laryngomalacia
What is the most likely cause of high pitched inspiratory stridor in a newborn after traumatic birth who has a weak cry?
Vocal cord paralysis after recurrent laryngeal nerve injury
What diagnosis presents as a newborn with stridor and retractions that is worse with agitation and in the supine position?
Laryngomalacia
What diagnosis presents as progressive hoarseness without stridor or dysphasia? How would you confirm this diagnosis?
Vocal cord nodules
Laryngoscopy
What should you do in a patient with symptoms of laryngomalacia who presents with difficulty feeding and failure to thrive?
Search for a different cause as laryngomalacia does not present with feeding difficulties
What diagnosis presents with difficulty breathing but normal pulse ox and normal physical exam with no response to bronchodilators ?
Vocal cord dysfunction
What is the clinical difference between laryngomalacia and tracheomalacia?
Laryngomalacia presents with inspiratory stridor and improvement during expiration but tracheomalacia presents with expiratory stridor
What diagnosis presents with expiratory stridor and feeding difficulties?
Vascular ring
What two past medical problems can cause symptoms of expiratory stridor later?
Chronic ventilation
TE fistula repair
What presents as biphasic (inspiratory and expiratory) stridor ?
Subglottic stenosis
Epiglottitis (supraglottic stenosis)
What is the best appropriate step in a 4 y/o make with inspiratory stridor who is leaning forward and drooling with dysphasia and dysphonia?
Evaluation with anesthesiologist prepared for intubation
Third generation cephalosporin
What is the classic X-ray appearance in a patient with epiglottitis ?
Thumb sign
What is the appropriate method to diagnose a vascular ring?
Barium swallow
What is the appropriate test to diagnose vocal cord function?
Flexible nasolaryngoscopy or direct laryngoscopy
CXR and barium swallow
How would you diagnose subglottic stenosis ?
Direct laryngoscopy and bronchoscopy
What diagnosis presents in an 18 month old male with low grade fever and hoarse barking cough with stridor ? What are the most common causes of this condition ?
Laryngotracheobronchitis (croup)
RSV, flu or parainfluenza
What disease should you consider in a patient who is not immunized and presents with croup?
Measles
What is the appropriate treatment for croup?
Racemic epinephrine
Cool mist
Decadron
What is the next step in a patient with viral croup who rapidly deteriorates with toxic appearance and thick purulent secretions who prefers to lay supine?
Prepare for intubation &
Broad spectrum antibiotics for Bacterial tracheitis
What are the 4 common causes of pseudomembranous croup?
(Aka bacterial tracheitis) Staph aureus Moraxella catarrhalis H. Flu and Oral anaerobes
What diagnosis presents with lateral neck films showing ragged air column and subglottic narrowing?
Bacterial tracheitis (aka membranous laryngotracheitis or pseudomembranous croup)
What diagnosis presents as recurrent nightly croup without fever or uri symptoms ? How would you treat this condition ?
Spasmodic croup (non infectious) - symptomatic treatment plus steroids if needed
What is the next step in a patient who you find to have a bifid uvula? What is this finding associated with?
Tympanometry
Submucous cleft palate
What is the appropriate treatment in a patient with laryngeal papilloma? What is the common cause?
Laser excision
HPV (?child abuse)
What is the likely diagnosis in a patient with midline neck lesion that moves vertically with swallowing? What is the appropriate treatment?
Thyroglossal cyst - do not surgically remove as this is functioning thyroid tissue
What diagnosis presents as mobile and tender neck nodes without erythema or warmth?
Reactive cervical adenopathy
What diagnosis presents as tender, red and warm neck nodes?
Lymphadenitis
What diagnosis should you consider in a patient with pre-auricular adenopathy and conjunctivitis ?
Adenovirus
What 2 diagnoses should you consider in a patient with chronic cervical lymphadenopathy?
HIV
TB
What antibiotics should be started in a patient with bacterial lymphadenopathy ?
Unasyn and clinda
What diagnosis should you consider in a patient with cervical adenopathy with 5mm PPD finding? How should you treat?
Atypical mycobacteria - surgical excision (not needle excision)!
What diagnosis should you consider in a patient with chronic adenopathy and hepatomegaly with hx of exposure to farm animals ?
Brucellosis
What diagnosis presents as an enlarged soft cervical mass that is caused by dilated lymph vessels?
Cystic hygroma
What diagnosis should you consider in a patient with fever and parotid swelling in a school aged child, there is swelling and erythema inside the mouth but no pus can be expressed with parotid massage and there is no erythema of overlying skin?
Viral parotitis
What diagnosis presents in a school aged child who is toxic appearing with high temperature and parotid swelling ? What is the most common cause of this ?
Bacterial parotitis - staph aureus
You are presented with an adopted child from a developing country with 2 weeks parotid swelling resistant to antibiotics. The patient has received multiple vaccines but they are not well documented. What should you consider?
HIV ( because you have no parental information and vaccines have been given )
