ENT

Question 1

what are the signs of a peritonsillar abscess? how do you tx?

Answer 1

sx: ST for several days that has worsened on one side, fullness of anterior tonsilla pillar, uvular deviation from side of abscess, hot potato voice, trismus tx: drainage or aspiration, adequate pain control, abx, tonsillectomy for some. If in back of throat call ENT.

Question 2

what are these a sign of: high fever, sore throat, dyspnea, rapidly progressive respiratory obstruction and prostatration.presents over 2-4 hours. Look for 4 Ds: drooling, dysphagia, dysphonia-hoarseness, distress/stridor. how do you tx it?

Answer 2

epiglottitis.tx: do not leave unattended in exam room! Establish and maintain airway or all ENT for surfical airway. Give abx and corticosteroids to reduce edema: cefotaxime or ceftriaxone + vancomycin.can give racemic epi. DO NOT LEAVE UNATTENDED. Tx all in householdwith rifampin if they have any other members that are immunocompromised, or if they are not yet completely vaccinated.

Question 3

stridor, barking cough + steeple sign on CXR. how to tx?

Answer 3

croup. don’t do any procedures to make them nervous b/c you can lose an airway. Use racemic epi + dose of steroids. If still hear stridor, keep them overnight.

Question 4

what should you always check with people with facial trauma? what kind of tests do you do?

Answer 4

ABCs and always check ocular movement and vision for nerve entrapment! always check ocular movement and vision for nerve entrapment! Look at symmetry from top down and down up. Get spiral CT of head, face, and NECK. Get whole spine if you suspect cervical spine fracture.

Question 5

what kinds of signs might you see in a le fort fracture?

Answer 5

le fort fractures you may see swelling of face, elongated depressed facial features, palpable depressed fractures, CSF may be coming out of nose +/-blood. teeth might not fit togther and there may be a septal hematoma.

Question 6

what bones are involved in a tripod fracture?

Answer 6

Tripod fracture is a set of 3 bone fractures: maxillary sinus (includees anterior and postero-lateral and floor of orbit), zygomatic arch, and the lateral orbit rim at zygomatico frontal suture. +/- involvement of sphneozygomatic suture.

Question 7

what kind of tests do you do and how do you tx someone with laryngeal trauma?

Answer 7

chest and c-spine xrays, +/-endoscoy if airway stable or neck CT.. for penetrating and blunt trauma: ABCs, close observation, admit to ICU, best rest with hOB elevated. Voice rest (no whispering!), humdified air, clear liquid diet, steroids possibly in first few days. +/- surgical exploration and repair for penetrating wounds.

Question 8

what sx will you see with longitudinal or transverse temporal bone fractures?

Answer 8

with longitudinal temporal bone fracture you can have TM bleeding, +/-conductive hearing loss, possible sensorineural loss. With a transverse fractureyou can get the same symptoms plus CSF from nose, loss of vestibular fcn and brusing behind mastoid bone.

Question 9

which test is not helpful for nasal trauma? which is most helpful? what other things should you check?

Answer 9

X-rays; most helpful is PE. PE best. Look for deformity, septal hematomas,. Make sure they can breathe on both sides and check ocular movements.

Question 10

how do you identify ludwig’s angina? what tests should you do? how to tx?

Answer 10

may have hx of recent dental procedures, URI, resp difficulty, immune compromise or trauma. Usu have mouth pain, drooling, stiff neck, muffled voice. +/- tongue sticking out which is really bad. tests: CT with contrast. tx: abcS. May need trach. Abx to cover anaerobes. Surgical drainage as needed. THINK LUDWIGS ANGINA ANY TIME YOU HEAR TROUBLE SWALLOWING + SWELLING.

Question 11

what other infection can have the same sx as ludwigs angina of fever, stiff neck, drooling, and dysphagia? ? how do you distinguish the two?

Answer 11

retropharyngeal and prevertebral space abscess. use CT with contrast to distinguish also ludwigs angina would have more swelling. you tx them the same with ABCs, abx and surgical drainage.

Question 12

what’s in the ddx for ST?

Answer 12

viral pharyngitis MC, bacterial pharyngitis, mononucleosis, peitonsillar abscess, retropharyngeal abscess, candidiasis, sinusitis (PND), allergy, dryness, GERD, thyroiditis, epiglottis laryngitis, neoplasm/cx, foreign body, chemical exposure, referred pain (dental, ear, LN, chest) influenza

Question 13

what are the center criteria/indicaitons for rapid strep test?

Answer 13

indications for rapid strep test: fever by hx, tender anterior cervical lymph nodes, exudate on tonsils, lack of cough +/- exposure to strep, odynophagia HA, nausea, vomiting and/or abdominal pain, rash

Question 14

what’s the tx and pt ed for mono?

Answer 14

tx: mostly non pharm and pt ed: rest, fluids, analgesics. Can use abx for strep throat but they’ll get a rash. pt ed: contagious via saliva. If splenomegaly can’t play contact sport for at least 7-8 wks, 4 wks can do sports, just not contact. Reevaluate.the fatigue can linger for 2-3 mo.but the sore throat will only last 1-2 wks.

Question 15

signs/sx of epiglottis

Answer 15

high fever, sore throat, dyspnea, rapidly progressive respiratory obstruction and prostatration.presents over 2-4 hours. Look for 4 Ds: drooling, dysphagia, dysphonia-hoarseness, distress/stridor

Question 16

how do you distinguish croup from epiglottiis?

Answer 16

there will be more reps distress in epiglottis, there will be drooling, abscensce of barking cough. croup preceded by URI.

Question 17

what’s on your ddx for neck mass?

Answer 17

how old? How long has it been there? Pain? Cough? Bleeding? Do they smoke or drink? Other medical issues? Size?consistency? Where is it?
ddx: infectious/inflammatory: LAD from virus, fungus, bacteria, TB, abscess, sialadenitis (swollen saliva gland) congenital: thyroglossal duct cyst, branchial cleft cyst, dermoid neoplastic masses benign: lipoma, schwannoma (nerve tumor), salivar gland tumor, thyroid tumor, neoplastic masses malignant: metastatic squamous cancer, lymphoma, salivary gland cx, thyroid cx

Question 18

what are important questions to ask someone with a neck mass?

Answer 18

how old? How long has it been there? Pain? Cough? Bleeding? Do they smoke or drink? Other medical issues? Size?consistency? Where is it? Prior tx for anything? Travel? Pets? (toxoplasmosis), inciting events. Wt loss? Dysphagia, hoarseness (>2-3 wks), hemoptysis, fever (infection), chills, sweats, frequent uRI or strep throats? previous masses? tobacco and etoh use (synergistic=25x more likely to have cx, sexual partners (HPV), work history

Question 19

which neck mass is in the center of the neck, usu comeson after a URI, moves with swallowing, and is usu non tender unless infected. is it worrisome?

Answer 19

its a thyroglossal duct cyst, not worrisome, its congential

Question 20

what is the tx for masses in thyroid and parotid gland?

Answer 20

surgery is mainstay

Question 21

what’s the last resort for biopsying masses in throat?

Answer 21

open biopsy b/c you can change the way their lymph nodes drain and its hard to know where the cx could go next. fine needle aspiration is best.

Question 22

what are the RFs for head and neck cx?

Answer 22

etoh, smoking synergism of these, betel nut, HPV (on the rise), general sources of inflammation

Question 23

which cx patients are most likely to commit suicide?

Answer 23

those with head and neck cx

Question 24

what are worrisome signs or sx of head and neck cx?

Answer 24

any of the following lasting 3 wks or more: hoarseness, hemopytsis, dysphagia, odynophagia, oral bleeding, ST, loose tooth not explained by trauma, otalgia, lumps/bumps in Hand N area, cranial nerve dysfcn–NEEDS IMMEDIATE CONSULT.

Question 25

how do you tx head and neck cx?

Answer 25

5 year survival rate is 61%! Can do surgical extirpation (cut out) and radiation=mainstay. +/- chemo. Need reconstructive surgery. Can do radiation or surgery alone for earlydisease (TNM I or II). Need chemo and surgery for TNM III or IV. Req’s 7-8 wks of daily tx. novel approaches of transoral laser and robots. mets first to cervical LN. need to remove these too. can inject a dye, see what node it goes to first, and remove that “sentinel node” to be safe.preseve cranial nerves!

Question 26

what are the two objective tests used to measure infants hearing and those up to 6 mo?

Answer 26

auditory brainstem response (ABR) and otoacoustic emissions testing (OAE)

Question 27

what type of hearing procedure is used for someone 6 mo to 3 yo of age?

Answer 27

visual reinforcement audiometry (VRA) an animal will light up when the kid looks

Question 28

what kind of hearing test is used for someone 3-6 yo age?

Answer 28

conditioned play audiometry: the place a peg in a board when they hear the sound

Question 29

what’s the range of decibels for normal hearing?

Answer 29

-10 to 20 decibels

Question 30

how many hours do you have before hearing loss is permanent?

Answer 30

13 dyas

Question 31

what dz do these sx signify?

Answer 31

xerostomia, keratoconjuctivitis sicca (def of tear production=dry eyes), parotid gland swelling, sublingual gland swelling= cotton mouth and trouble swallowing dry food or burning/itching or foreign body sensation. dry ness can effect other areas: painful intercourse, dysphagia. other systemic sx: small vessel vasculitis, obstructive airway dz, ILD without hx of smoking.

Question 32

what are possible PE and lab findings in someone with sjogre’s syndrome?

Answer 32

elevated ESR, hypergammaglobulinemia. +Rh factor. +ANA presentce of anti-SS-A and Anti-SS-B. bx of lip will show lymphocytic infiltratio and ductal hyperplasia. Schirmer’s test of putting filter paper in mouth will show that

Question 33

what’s suppurative parotitis? what pathogen usu causes it? who is at risk?

Answer 33

acute infectin of parotid gland. usu d/t staph aureus or anaerobes. Rsf: usu in elderly post op with dejydration or h/o intubation. anticholingeric use, malnutrition, salivary calculi, oral neoplasm

Question 34

what are the RFs for glossitis?

Answer 34

nutritional deficiencies (iron, vit b12, folic acid), dry mouth (sicca sx), sjogren syndrome, oral candida infection, protein calorie malnutrition in older pops, celiac dz, injury/trauma or poor fitting dentures, rough teeth, trauma, burns, tobacco, alcohol

Question 35

who is most likely to get herpetic stomatitis? what are some of the signs or sx? how is the dx made? tx?

Answer 35

usu kids; may have hx of pharyngitis. Drooling, vesicular lesions, shallow ulcerations. LAD. Fever, irritability, pain, decreased eating. dx clinical +/- viral serology. tx: fluids, pain relief, self limited to 7-14 days, antiviral if present within first 72-96 hours (acyclovir)

Question 36

how do you tx canker sores?

Answer 36

self limited to 10-14 days, can do a topical steroid orabase or topical anesthetic. Use good hygiene, tx undelrying dz.