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PANRE 2016 > ENT > Flashcards

ENT Flashcards

1
Q

in CHL Weber test lateralizes to what ear? What is the Rinne finding?

A

Affected ear for Weber. BC>AC for Rinne

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2
Q

In SNHL what are the Weber and Rinne findings?

A

Weber - lateralizes to unaffected ear, Rinne AC>BC

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3
Q

Retraction of TM or a perforation with visible keratin coming out or granulomatous tisse. What is is caused by? Tx?

A

Cholesteatoma. Chronic OM with effusion. Refer for surgical repair

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4
Q

Abnl growth of bone on stapes causing CHL first then SNHL - often hereditary

A

Otosclerosis

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5
Q

Anatomic cause of SNHL

A

Detioration of cholear hair cells or lesions in CN8 pathway

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6
Q

What meds are ototoxic?

A

Aminogylcosides, Vancomycin, Lasix, Cisplatin, ASA

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7
Q

Unilateral hearing loss (gradual or sudden), tinnitis and continuous disequilibrium

A

Acoustic Neuroma

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8
Q

Presents with TM perforation, vertigo, hemotympanum or SNHL. Pt was just on a flight or scuba diver

A

Barotrauma

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9
Q

How to prevent barotrauma

A

yawning, autoinflation, swallowing

or topical/systemic decongestants

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10
Q

Pt presents with popping/crackling, aural fullness, mild-moderat hearing loss and suffers from allergies or just had a cold. How does TM look on exam? Tx?

A

Eustachian tube dysfunction. Retracted TM, tx with antihistamines and anti-inflammatoy meds

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11
Q

Tx of foregn body in ear canal?

A

Animate - mineral oil or lidocaine and extract

Inanimate - attempt removal or refer to ENT for removal

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12
Q

Tx of auricular hematoma?

A

I&D and compression

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13
Q

Complication of repeat trauma to ear cartilidge

A

Cauliflower ear

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14
Q

Pathogens for mastoiditis

A

Typically S. pneumoniae / H. influenza (related to AOM) or S. pyogenes
(related to pharyngitis)

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15
Q

Infection of mastoid air cells that typically occurs after

untreated AOM

A

Mastoiditis

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16
Q

presents with fever, postauricular erythema, and pain. What test to order?

A

Mastoiditis - CT scan reveals coalescence of mastoid air cells due to destruction of
their bony septa

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17
Q

Presents with otalgia, hearing loss, discharge, bleeding, dizziness or nystagmus (depending on extent of injury) Tx?

A

TM perforation - Usually heal spontaneously, monitor for secondary infection

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18
Q

How do you evaluate and tx tinnitis?

A

Audiometry, MRI +/- venography,

Tx - avoid noise or ototoxic agents, hearing aid may help

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19
Q

What med can be used for tinnitis?

A

Oral antidepressants (nortriptyline)

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20
Q

Acute onset of continuous, severe vertigo lasting days to

weeks with hearing loss and tinnitus - usually following a URI

A

Labyrinthitis

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21
Q

Tx of Labyrinthitis

A

Symptoms typically resolve over weeks, however hearing loss may be permanent.
Tx - supportive measures – meclizine or promethazine

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22
Q

Distention of endolymph compartment of inner ear

A

Meriere Syndrome

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23
Q

Episodic vertigo (20 min to several hours), low
frequency SNHL, tinnitus and sensation of unilateral
aural pressure

A

Meniere Syndrome

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24
Q

Tx of Meriere Syndrome

A

Treatment:
– Decrease dietary sodium
– HCTZ and meclizine
– Referral to ENT

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25
Q

Recurrent episodes of vertigo; associated with changes in
position of head and possibly nausea/vomiting; gait
instability

A

BPPV

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26
Q

Tx of BPPV

A

Meclizine and diazepam

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27
Q

Pathogens for acute Sinusitis

A

• Bacteria pathogens – S. pneumoniae, H. influenza, M.
catarrhalis and S. aureus
• Viral: rhinoviruses, adenoviruses,
influenza/parainfluena

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28
Q

Most commonly caused by viral infections associated with viral URI, but may follow an allergy exacerbation

A

Acute sinusitis

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29
Q

URI symptoms: purulent rhinorrhea, maxillary tooth pain,
nasal obstruction, facial pain,(pressure or fullness)
Nasal cavity/turbinate edema

A

Acute Sinusitis

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30
Q

Test for sinusitis

A

– Plain films have poor sensitivity and specificity

– CT helpful in severe cases

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31
Q

Tx of acute sinusitis

A

Symptomatic
– Pain management (NSAIDS, APAP, or opioid)
– Nasal saline (Neti pot)
– Intranasal steroids in the first 5 days
– Short course nasal or systemic decongestants
May use anitbiotics:
May be considered in patients with:
• Acute sinusitis that does not improve within 7 days or that worsens at any
time
• Moderate to severe pain or T ≥ 101° F
• Immunocompromised patients

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32
Q

First line tx for acute sinusitis

A

1st line (7-10 days)
• Amoxicillin
• TMP-SMZ or Doxycycline (PCN allergic)

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33
Q

Second line tx for acute sinusitis

A

2nd line (10 days) – if no improvement
• Amoxicillin-clavulanate (after 3 days of 1st line)
• Moxifloxacin (after 3 days of 1st line)

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34
Q

Complications of Acute Sinusitis

A 
• Bony complications
– Osteomyelitis (frontal sinus osteomyelitis – Pott Puffy Tumor)
• Orbital complications
– Preseptal/periorbital/orbital cellulitis
– Cavernous sinus thrombosis
• Intracranial complications
– Meningitis
– Epidural/subdural/cerebral abscesses
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35
Q

Presents with H/A, nasal congestion, sneezing or pruritis, clear rhinorrhea and increased lacrimation in the spring

A

allergic rhinitis

36
Q

Tx of allergic rhinitis

A

1st line: Intranasal steroids – (ex. Fluticasone (Flonase), mometasone (Nasonex)
2nd line options - combination therapy may be indicated for severe/persistent symptoms
• Oral antihistamines (1st generation – diphenhydramine, 2nd generation –
loratidine, desloratidine, fexofenadine)
• Intranasal antihistamines
– Azelastine (Astelin) and olopatidine (Patanase) currently available
• Sympathomimetics (decongestants)
– Topical not recommended due to possibility of rhinitis medicamentosa (tachyphylaxis & rebound nasal congestion)
• Intranasal cromolyn
• Montelukast (Singulair)
• Immunotherapy

37
Q

Epistaxis occurs from trauma to what?

A

Kesselbach’s plexus in anterior septum

– Also think about cocaine use, sinusitis, leukemia, coagulation disorders

38
Q

Yellowish, boggy masses of hypertrophic mucosa, nasal

congestion and decreased sense of smell

A

nasal polyps

  • often in pt’s will atopy or allergies
  • think CF in kids
39
Q

Acute pharyngitis - viral vs bacterial causes

A 
80% are viral in etiology
viral:
Rhinovirus, adenovirus, enterovirus, EBV and HSV
bacterial:
GABHS, mycoplasma, gonococcal
40
Q

pt presents with fever, acute sore throat, adenopathy,
tonsillar edema, erythema and exudate, scarlatina rash
– Absence of conjunctivitis and cough

A

strep pharyngitis

41
Q

Centor criteria for strep pharyngitis

A 
Centor criteria
– Fever over 38°C
– Tender anterior cervical lymphadenopathy
– Tonsillar exudate
– Lack of a cough
tx if 3-4 criteria
rapid strep if 1-2 criteria
42
Q

Tx of strep pharyngitis

A

PenVK or cefuroxime

• Azithromycin/Clarithromycin or erythromycin in penicillin allergic patients

43
Q 
Presents with severe sore throat, pain on swallowing
or opening mouth (trismus), deviation
of soft palate and uvula and a muffled
voice
Dx and tx?
A

Peritonsillar abscess
Tx: Aspiration and drainage, and
antibiotics – amoxicillin, amoxicillin-sulbactam,
and clindamycin

44
Q

presents with fever, throat pain and pain with swallowing - sitting in sniffing position

A

Epiglottitis

45
Q

“thumbprint sign” on Lateral ST neck film

A

Epiglottitis

46
Q

Tx of epiglottitis

A

IV antibiotics, IV steroids,admit and possible intubation

47
Q

Single or multiple small shallow ulcers with yellow grey fibrinoid centers with red halos found on labial and buccal mucosa

A

apthous ulcers

48
Q

what causes apthous ulcers?

A

unknown but HSV 6

49
Q

Tx of apthous ulcers

A

viscous lidocaine, topical or oral steroids

50
Q

what med can be used for maintenance tx of apthous ulcers

A

cimetadine

51
Q

white patches in mouth that can be scraped off

A

oral candidiasis

52
Q

tx of oral candidiasis

A

oral antifungal

53
Q

tx or oral HSV

A

oral antiviral

54
Q

fixed white lesions that can’t be scraped off

A

oral leukoplakia

55
Q

causes of oral leukoplakia

A

chronic irritation in tobacco users and denture wearers

56
Q

leudkoplakia or erythroplakia think

A

oral squamous cell CA

57
Q

pt’s at risk for oral squamous cell CA

A

tobacco users and use of alcohol

58
Q

tx of benign migratory glossitis

A

goes away on it’s own

59
Q

red smooth surfaced tongue

A

glossitis

60
Q

causes of glossitis

A 
nutritional deficiency (niacin, riboflavin, vit E), chemo, dehydration
-if unsure of cause tx for nutritional deficiency
61
Q

redness and swelling of gumline

A

gingivitis

62
Q

tx of gingivitis

A

brush, floss, cleaning q 6 mths

63
Q

dental abscess - cause, dx, tx

A

from a cavity, exam and Xray, refer to dentist - PCN or clindamycin

64
Q

most common cause of hoarseness

A

acute laryngitis

65
Q

cause of acute laryngitis

A

almost always viral - following an URI - like 1 week after

66
Q

tx of acute laryngitis

A

rest vocal cords and symptomatic treatment

67
Q

new and persistent hoarseness > 2 weeks (in a smoker), hemoptysis, persistent throat or ear pain with swallowing

A

laryngeal squamous cell CA

68
Q

risk factors for laryngeal CA - dx, tx

A

smoking and HPV (non-smokers), bx and CT/MRI, radiation and surgery and possibly chemo

69
Q

acute swelling, increased pain and swelling with eating

A

sialadentis

70
Q

what glands most often affected with sialadentis

A

parotid

71
Q

causes of sialadentis

A

dehydration and chronic illness

72
Q

cause of sialadentis

A

s. aureus

73
Q

tx of sialadentis

A

rehydration, warm compresses, massage, and antibiotics (nafcillin, clindamycin or augmentin

74
Q

calculus in salivary gland

A

sialolithiasis

75
Q

most common duct for sialolithiasis

A

Wharton’s duct (drains submandibular gland)

76
Q

two ducts affected by sialolithiasis

A

Wharton’s and Stenson’s

77
Q

what drains submandibular gland

A

Wharton’s duct

78
Q

what drains parotid gland

A

Stenson’s duct

79
Q

postprandial pain and localized swelling

A

sialolithiasis

80
Q

tx of sialolithiasis

A

refer to ENT

81
Q

most common location of salivary gland tumors

A

parotid gland (80%)

82
Q

symptom of salivary gland tumor

A

asymptomatic swelling

83
Q

tx of salivary gland tumor

A

refer to ENT

84
Q

young person with gingival inflammation & necrosis,
bleeding, pain, halitosis, fever,
cervical lymphadenopathy

A

necrotizing ulerative gingivitis aka trench mouth

85
Q

cause of necrotizing gingivitis and tx

A

caused by stress
tx: salt water +/- peroxide rinses, oral
hygiene, oral penicillin

PANRE 2016 (2 decks)

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