ENT Flashcards
Unilateral vs. Bilateral Choanal Atresia
Unilateral: mucopurulent discharge
Bilateral: neonate unable to breathe, neonates are obligate nasal breathers. Montgomery nipple can be used as interim measure prior to surgery.
infection of floor of mouth, tongue pushed back and obstructs the airway
Ludwig’s Angina
Where does infection spread if the second or third molars are abscessed?
submandibular and parapharyngeal space
Where does infection spread from the first molar forward?
sublingual space
DO NOT ATTEMPT INTUBATION
collection of purulence in the space between the tonsil and the pharyngeal constrictor
Peritonsillar abscess
Hallmark signs of peritonsillar abscess
- fullness of anterior tonsillar pillar
- Uvular deviation AWAY from side of abscess
- “hot potato” voice
- trismus (difficulty opening jaws) in some patients
How do patients with foreign bodies in their airway typically present?
unexplained cough or pneumonia
Where does mucormycosis spread?
starts in sinuses, spreads to nose, eye, and palate, then goes up the optic nerve to the brain
Treatment of mucormycosis
- correction of acidosis and metabolic stabilization
- debridement, medial maxillectomy and orbital exenteration if necessary
- Amphotericin B
Treatment for anterior nosebleed
oxymetazoline or phenylephrine nasal spray and digital pressure for 5–10 minutes.
Bleeding from the back of the nose in an adolescent male is considered to be ____________ until proven otherwise.
juvenile nasopharyngeal angiofibroma
Osteomyelitis of temporal bone, with fatal complications
Necrotizing Otitis Externa
What is necrotizing otitis externa usually caused by?
Pseudomonas
Who usually gets necrotizing otitis external?
diabetes and AIDS patients
idiopathic, unilateral, sensorineural hearing loss with onset over a period of less than 72 hours
Sudden Sensorineural Hearing Loss (emergency!)
Common bacteria that cause otitis media in children
Strep pneumo
H. influenzae
Moraxella catarrhalis
First line therapy for otitis media
amoxicillin dosed at 80 to 90 milligrams per kilogram per day
Factors that reduce acute otitis media in children
- Breastfeeding
2. pneumococcal conjugate vaccine
Factors that increase acute otitis media in children
- daycare attendance
- young siblings at home
- exposure to tobacco smoke
When should children get pressure equalization tubes?
3-4 bouts of acute otitis media in 6 mo, or 5-6 bouts in a single year
Unilateral OME in an adult–what should you rule out?
Early nasopharyngeal carcinoma
Purulent ear drainage in the setting of acute otitis media is likely _________.
TM perforation
firm submucosal scarring that can appear as a chalky white patch on the eardrum
tympanosclerosis
fever, ear pain, and a protruding auricle
think acute mastoiditis and get a CT!
eardrum layers
cuboidal epithelium in the middle ear, a fibrous layer in the middle, and squamous epithelium on the outside
hereditary disease process that involves bony proliferation within the temporal bone
otosclerosis
candidates for cochlear implant
Patients with bilateral profound hearing loss and younger children are candidates for cochlear implant
illusion of motion
true, peripheral vertigo
What does ENG testing involve?
- calibration test: measure rapid eye movements
- tracking test: ability of eyes to track a moving target
- positional test: response to head movements
- caloric test: responses to cold and warm water in ear canal
GOLD STANDARD for detecting unilateral peripheral vestibular disorders
What is the gold standard for testing bilateral vestibular weakness?
rotatory chair testing
How is BPPV treated?
Epley or Semont maneuver: canolith repositioning
thought to be caused by inflamma- tion, secondary to a viral infection, of the vestibular portion of the eighth cranial nerve or of the inner ear bal- ance organs (vestibular labyrinth).
vestibular neuronitis
Vertigo duration times
BPPV: 60 s
Vestibular neuronitis: 24-48 hrs
Meniere’s: 30 min-4 hrs
Acute unilateral facial nerve paresis or paralysis with onset in less than 72 hours and idiopathic.
Bell’s palsy
Bell’s palsy treatment
oral steroids within 3 days of onset
facial nerve paralysis is accompanied by severe pain and a vesicular eruption in the external auditory canal and auricle in the distribution of the facial nerve
Ramsay-Hunt syndrome
Most common cause of frontal lobe abscess
frontal lobe sinusitis
the osteomeatal complex
the region through which the maxillary, eth- moid, and frontal sinuses drain in the nose. An obstruction of the OMC will frequently lead to sinusitis, and is often due to mucosal edema or anatomic abnormalities.
inverted papilloma
a benign growth caused by human papilloma virus
widened thyroid car- tilage, subcutaneous air [crepitus], neck bruising, hoarseness, coughing up blood
fractured larynx
How long does it take for scars to cosmetically mature?
1 year
What usually causes bilateral parotid enlargement?
viruses, including HIV and mumps
Sjogren’s can cause parotid enlargement
Where do salivary stones most often occur?
submandibular duct
What is the most common metastatic lesion to the parotid gland?
squamous cell carcinoma
malignant melanoma cause also
most common benign salivary tumor
pleomorphic adenoma
most common malignant salivary tumors
adenoid cystic carcinoma
mucoepidermoid carcinoma
T/F: a thyroid nodule in a male has a higher risk of being cancerous than a nodule in a female.
T
Thyroid cancer with clear nuclei and psammoma bodies
papillary thyroid cancer
What is essential for diagnosis of follicular thyroid cancer dx?
evidence of capsular invasion
How does follicular ca metastasize?
via the blood
Sign of foreign body in a child’s nose
unilateral, foul smelling, purulent rhinorrhea
When is tonsillectomy indicated?
tonsillectomy is indicated when children present with seven or more infections per year, five per year for the past two years, or three per year for the past three years.
stridor, leaning forward in a tripod posture, and drooling because it hurts to swallow
acute epiglottis
Abscessed teeth can rupture through the medial mandibular cortex into the sublingual space. This can cause the tongue to be pushed up and back. The biggest danger in this is loss of _____________.
airway
The easiest way to ensure that the airway isn’t lost in this situation is to perform a ____________.
tracheotomy
Immunocompromised patients, especially patients with diabetes, can get a devastating fungal infection of the sinuses called ________________.
mucormycosis
Necrotizing otitis externa is a Pseudomonas infection of the _______ and _____, which can lead to fatal complications.
skull base or temporal bone
Often, _______ tissue is seen at the junction of the bony-cartilaginous junction in the external auditory canal in patients with necrotizing otitis externa.
granulation
The most common cause of a nosebleed in children is injury to vessels in ________________.
Kiesselbach’s plexus
A posterior nosebleed in an adolescent male is considered to be a ___________ until proven otherwise.
juvenile nasopharyngeal angiofibroma
Two topical vasoconstrictors often used in the nose are __________ and __________.
oxymetazoline, phenylephrine
Children with persistent otitis media with effusion for ___ months and evidence of hearing loss are candidates for PE tube placement.
3
Ear drainage in patients with PE tubes in place should be treated with _______________________.
ototopical fluoroquinolone drops
The presence of bilateral fluid in the ears may cause up to a __________ dB conductive hearing loss.
30 to 40