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
It is important to examine the ____________ in any adult with uni- lateral otitis media with effusion.
nasopharynx
In a patient with acute otitis media, in addition to being opaque and bulging, the eardrum has ____________ mobility on pneumatic otos- copy.
decreased
The collection of trabeculated bony cavities lined with mucosa and connected with the middle ear is called the mastoid ______________.
air cells
The pars flaccida of the eardrum can become _______________when there is chronic negative pressure in the middle ear.
retracted
The outside of the TM, including the pars flaccida, is lined with ____________ epithelium.
squamous
_________________ is suspected in a child presenting with fever, ear pain, a protruding auricle, and fluctuance behind the ear.
acute mastoiditis
In patients with chronic eustachian tube dysfunction, desquamated debris, consisting mainly of keratin, collects in the retracted pars flac- cida. Over time, this can grow and become a __________.
cholesteatoma
If a patient presents with a draining ear, appropriate therapy includes drops and ________________.
oral antibiotics
If ear drainage persists despite medical therapy, the patient requires referral to an otolaryngologist to rule out ______________.
cholesteatoma
____________________is the firm submucosal scarring that can appear as a chalky white patch on the eardrum.
tympanosclerosis
The most common cause of a conductive hearing loss in children is ________________.
OME
The magnitude of a hearing loss is documented in the _______.
audiogram
The two major types of hearing loss are ______________ and ________.
conductive, sensorineural
Conductive hearing loss is present when there is a difference between __________ and _____________ conduction thresholds.
air, bone
Sensorineural hearing loss is present when air and bone conduction thresholds are ______ but show a hearing loss.
approximate, similar
Noise-induced hearing loss often produces a high-frequency _________________ in the audiogram.
notch
Otitis media with effusion produces a ______________ tympano- gram.
Type B (flat)
Presbycusis produces a hearing loss that slopes to the _____________ side of the audiogram.
Downward, right
A patient with an asymmetric sensorineural hearing loss must be evaluated for the potential of having an ________.
acoustic neuroma
Dizziness associated with an illusion of motion is termed _____________.
Vertigo
Sudden vertigo that develops without ear symptoms and lasts for 24–48 hours is most likely ________.
vestibular neuronitis
______________________ is vertigo precipitated by posi- tional changes, lasting 10–60 seconds, and unassociated with serious illness.
BPPV
Peripheral facial paralysis can be due to: (3)
Tumors of parotid or skull base, infections, trauma
Facial paralysis without an identified etiology is termed ____________
Bell’s palsy
Facial paralysis is one symptom of damage to the facial nerve.
What other symptoms could the patient have?
___________, ___________, ___________, ___________, ___________.
Dry eye, dry mouth, taste disturbance, hyperacusis, numb ear lobe
A patient complains of fatigue, low-grade fever, purulent rhinorrhea, and headache that resolves within seven days. The most likely diagno- sis is a ______________________.
common cold
A patient had a typical cold that did not resolve in 10 days and has now had fatigue, purulent rhinorrhea, low-grade fever, and headache for three weeks. The most likely diagnosis is________.
acute rhino sinusitis
Another patient has similar symptoms for more than three months. This patient has ____________.
chronic rhinosinusitis
A common cause of nasal obstruction that is easily corrected by sur- gery is a _________.
deviated septum
Triad asthma (Samter’s triad) consists of asthma, nasal polyposis, and ____________.
aspirin allergy
Unilateral nasal polyps can either be caused by or be a manifestation of a _________________, and therefore warrant referral to an otolar- yngologist.
neoplasm
Any patient with symptoms of sinusitis and ____________ should be referred to an otolaryngologist immediately.
double vision
Patients should see an otolaryngologist if they have ____ episodes of sinusitis per year or if they have any ________ of sinusitis.
3-4, complication
In inhalant allergies, the T-helper cell system is abnormally weighted toward the __________.
Th2 side
If both parents have inhalant allergies, a child has a __________ per- cent chance of developing allergies.
60%
People with allergies produce excess Ig__________.
E
Trees typically pollinate and cause allergy symptoms in the season of __________.
Spring
Most inhalant allergies are a Gell & Coombes Type __________ hypersensitivity reaction.
I
IgE populates the outer surface of __________ cells.
Mast
Mast cells contain preformed allergic mediators, including __________, or _______________, or________________.
histamine, proteoglycans, proteases
Medications that are a contraindication to allergy skin testing include ___________, or _____________, or ________________.
beta blockers, tricyclic antidepressants, MAOIs
The main medication that must be discontinued three to five days before skin testing is __________.
antihistamines
The most serious adverse reaction to allergy skin testing or immuno- therapy is __________.
anaphalaxis
CT scans are typically obtained in the coronal plane, because this view best demonstrates the ____________.
Osteomeatal complex (OMC)
The first priority in management of maxillofacial trauma is securing the _______________.
airway
In an unconscious patient, the most common cause of airway obstruction is ________________.
Prolapse of the tongue posteriorly
Two reasons that oral endotracheal intubation may be contraindi- cated are _______ and ___________.
A broken neck, massive trauma with distortion of landmarks and bleeding
A contraindication to blind nasotracheal or nasogastric intubation is ________________.
Cribiform plate fracture
The nerve that is commonly not evaluated upon initial presentation, but whose management depends greatly on the examination at the initial time of presentation is the _______________ nerve.
facial
A fractured nose can be reduced in up to 14 days without complica- tions; however, a __________________________ must be ruled out at the time of the initial fracture.
septal hematoma
The most important part of any rhinoplasty is maintaining or improv- ing the ________________.
airway
The first principle in the management of soft-tissue wounds is _____________________.
meticulous reapproximation
Bacterial parotitis is most commonly caused by _________________.
S. aureus
A lump in front of or below the ear is to be considered a ______________ until proven otherwise.
parotid mass
Treatment of most parotid tumors includes ______________ with dissection and preservation of the facial nerve.
superficial parotidectomy
The treatment of follicular cancer involves surgery plus ______.
radioactive iodine
Patients with medullary carcinoma should have a urinary ___________ screen.
metanephrine
The thyroid malignancy with the worst prognosis is __________ carcinoma.
anaplastic
The first step in the diagnostic evaluation of a thyroid nodule after the history and physical is usually ____________.
FNAB
The most common histopathologic diagnosis for cancer of the upper aerodigestive tract is _______________.
SCC
Cigarette smoke and alcohol work in a ______________manner to promote cancer.
synergistic
People who have one cancer of the upper aerodigestive tract may have another primary malignancy in the upper aerodigestive tract. This is called synchronous primary, which is one of the reasons why ______________ is performed.
triple endoscopy
Taking a biopsy and evaluation of the actual size of a tumor are two other reasons why _________ is performed before final treatment of a head and neck cancer.
endoscopy
Small head and neck cancers can often be treated with either _____________ or ____________.
surgery, radiation
Large head and neck cancers are often treated with __________, _____________, and ___________________.
surgery, radiation, chemo
Squamous cell carcinoma of the head and neck usually metastasizes to the lymph nodes in the ______________before going to other sites.
neck
A radical neck dissection (RND) involves removing the sternocleido- mastoid muscle, the spinal accessory nerve, and the _____________, which are intimately related to the lymphatic structures of the neck.
jugular vein
Radiation therapy dries up the ______________________ glands.
salivary
A mass in the neck may be a _________from a cancer somewhere in the upper aerodigestive tract.
metastasis
A patient who is hoarse for more than two weeks may have _______________ of the larynx.
cancer
A patient with a lump below or in front of the ear may have a tumor of the _________ gland and needs to see an otolaryngolo
parotid
A persistent oral ____ may be the first sign of a cancer.
ulcer
When there is a normal ear exam, ________ may be caused by a can- cer in the pharynx.
otalgia
Persistent unilateral serous otitis media may be caused by a cancer in the nasopharynx obstructing the _______________.
eustachian tube
Parotid masses feel superficial, because the parotid gland is immedi- ately superficial to the ____________________ of the mandible.
ascending ramus
The three most common types of skin cancer are__________, _________ and___________.
Basal cell, squamous cell, malignant melanoma
Most basal cell carcinomas are nodular in appearance, with very dis- tinct borders, and are easily treatable. There is, however, a certain type that has very indistinct borders. This is called _____.
Morpheaform carcinoma
Certain basal cell carcinomas have a higher incidence of recurrence than others. These include ________________, _______________ and _____________________.
Recurrent, large (greater than 2 cm), and morpheaform
Some basal cell carcinomas may be very close to vital structures, such as the lower eyelid or the ala of the nose. In this case, maximum pres- ervation of tissue is a consideration, and these patients are candidates for ______ surgery.
Mohs’
Squamous cell carcinoma of the face is aggressive and commonly metastasizes to the _______________.
Cervical lymph nodes
The metastatic potential of malignant melanoma depends on _____________.
Tumor thickness
Signs of malignant melanoma are a mole that is __________, _____________, ____________, ______________ or _________________.
Darkly pigmented, raised, bleeding, changing, has irregular margins
Four indications for performing tonsillectomy are ___________, ____________, ____________, and _____________.
Recurrent tonsillitis, chronic tonsillitis, obstructive sleep apnea, asymmetric tonsils
A two-year-old boy presents with otitis media with effusion. The fluid has been present in his ears for three months, despite treatment with a three-week course of trimethoprim and sulfamethoxazole. His moth- er says that he is having trouble hearing. He has had one set of PE tubes in the past. You plan to place another set of PE tubes, and at this time you think that the child may also benefit from an ________.
adenoidectomy
Unilateral, foul-smelling rhinorrhea in a child is most commonly due to a ____________.
foreign body
A four-year-old girl presents at the emergency room with inspiratory stridor and a fever of 103°F, and she is drooling and leaning forward. Her mother states that the child was well four hours ago, and she thinks that the child swallowed a stick because her throat hurts now and she was playing with small sticks in the yard outside. Your first concern is that this child may have ____________.
acute epiglotittis
You then call the anesthesiologist and pediatrician, but while waiting for them to arrive, you notice that the child is starting to tire out. In fact, she becomes so tired from trying to breathe that she simply faints and ceases all attempts at respiration. The first thing you do for this child is __________________.
bag and mask ventilation
Your next patient in the emergency room is a one-year-old boy who presents with a chief complaint of stridor. He had a cold during this past week. On examination, he is not sitting up or leaning forward, and he is not drooling, but he has biphasic stridor. He does not have a fever, but he has a barking cough. The most likely diagnosis in this case is ________________________________.
croup
You therefore obtain a soft-tissue x-ray of the neck and a chest x-ray to look for the classic steeple sign. You are surprised when you find the child has actually aspirated a small metal object that appears to be the tip of a pen. Removal is with a rigid ______________________.
bronchoscope
A multiloculated cystic neck mass in a newborn child that transil- luminates is most probably a __________________.
Lymphatic malformation (lymphangioma or cystic hygroma)
A midline neck mass in a child that moves when the child sticks out his tongue, but is otherwise not tender and is found in the area of the hyoid bone, is most probably a ___________________________.
thyroglossal duct cyst
A two-year-old child presents to you with a high fever and large, painful, and inflamed left posterior triangle lymph nodes. The most likely diagnosis is __________________.
cervical adenitis
Another two-year-old child presents without fever and with no pain, but with large, firm lymph nodes in the posterior triangle of the neck. There are no lesions in the scalp seen on examination. In fact, the child seems to be almost oblivious to these nodes. The child does not have a cat, and has not been recently scratched by a cat or a dog. The most common cause of this type of neck mass in a child is ________________________.
atypical mycobacterial infection
A two-year-old boy presents to you with a fever of 103°F. His mother says he has not eaten anything all day and has vomited once. His neck is very stiff, and he will not move his head. He has had a cold over the last three to four days. You do an exam and find that his ears are not infected and he will not open his mouth at all, and he still will not move his head. You obtain CSF with a lumbar puncture (after noting the absence of papilledema on physical exam), and you send this to the lab. It returns with normal glucose and protein concentrations and no white blood cells. The opening and closing pressures are nor- mal, and the fluid is clear. Every time you try to look in the patient’s throat, he turns away, gags, and screams. You are thinking he may have retro or parapharyngeal cellulites or abscess, so you order a _____________________________.
soft tissue lateral neck x-ray
The lateral neck x-ray shows increased soft tissue thickness in the pre- vertebral area, but the child’s head is bent down, and it is somewhat difficult to diagnose a retropharyngeal abscess. The next diagnostic study you need is _____________________.
neck CT with contrast
The CT scan shows a large retropharyngeal node that is rim enhanc- ing and has a central lucency. Appropriate antibiotic coverage for this child would include covering the following organisms: _________ _______________, ____________, and ___________.
S. pneumoniae, H. influenzae, S. aureus, anaerobes
A two-year-old girl is brought by her mother for treatment of sinus- itis. She has been ill for two days and has a low-grade fever. Thick, clear mucus is streaming from both nostrils, and her ears are clear. She is otherwise awake, alert, and in no distress, and the rest of your physical exam is normal. You should __________________.
Reassure the mother and recommend follow-up if symptoms worsen or do not resolve within the next 10–14 days.
