ENT Flashcards
Sudden sensorineural hearing loss (SSHL)
timing, bilateral/unilateral?
most common cause + other categories
associated symptoms (2) possible workup (3)
treatment (3)
Onset over hours, usually unilateral
idiopathic; infection, hem/onc, vascular, metabolic, drugs
tinnitus, vertigo
MRI, ESR, FTA (syphillis test)
Tx: underlying cause, carbogen 95% O2, 5% CO2, steroids
Sudden sensorineural hearing loss (SSHL)
most common drug causes (4)
Loop diuretics (furosemide), salicylate, aminoglycoside, neomycin, vancomycin
Pictured disease
most common etiology
pathogmnemonic distribution
common cause
Perichondritis
Post traumatic (esp ear piercing)
spares pinna
Pseudomonas
TM perforation
natural history
early referral indications (2)
abx?
Infected tympanostomy tubes tx
Spontaneous healing
traumatic mechanism or posterior location
only if mechanism was forced water entry
ciprodex drops superior to oral abx
Otitis media
most common bacterial causes (1+2)
pictured disease
most common cause
treatment (2)
Strep. Pneumo [most common], H. influenzae, Moraxella catarrhali
Bullous Myringitis
NOT usually mycoplasma; usually same agent as underlying AOM
rupture bulla for pain relief, topical abx drops
Pictured disease
cause/findings (2)
Tx
Cholesteatoma
- Keratin-producing squamous epithelium overgrowth in the middle ear
- Often foul-smelling drainage
surgery
Dix-Hall-Pike
sensitivity for BPV
positive test =
vestibular neurontis vs labyrinthtis key differences - cause and sx
50 to 80%
burst of nystagmus, fast phase towards affected ear
VN: does not affect hearing; L: often affect hearing
VN: often post-viral; L: often viral infection
Meniere’s disease
cause
sx and pattern
tx (3)
Excess endolymph
paroxysmal tinnitus, vertigo, hearing loss -> progressive episodes (2-8h) and symptoms
low-salt diet, diuretics, steroids
Ototoxic drugs irreversible damage (3)
other common reversible causes (3)
Ramsay-Hunt =
irreversible: aminoglycosides, cytostatic, loop diuretics
reversible: NSAIDs, quinolones, antimalarials, erythromycin
Ramsay-Hunt = VZV affecting head/neck nerve, most commonly VII
Central vertigo causes (4)
Cerebellar/brainstem infarct or hemorrhage
vertebrobasilar insufficiency
MS (look for associated ataxia, optic neuritis)
basilar migraine
Sinusitis-causes (4)
complications of posterior pack (4)
CSF rhinorrhea antibiotics?
Most often viral, otherwise same as AOM: Strep. pneumo [most common bacterial cause] , H. flu., M. Cat., anaerobes
complications: hypoxia/CO2 retention (COPD, CHF, AMS), infection, aspiration of packing, sinusitis/AOM, cardiac ischemia
abx: controversial
Cauliflower ear and saddle-nose deformity: mechanism
salivary gland problems
bilateral parotitis cause
bacterial parotitis risk factors, common cause
siaolodenitis: location 80%
destruction of cartilage by blood-induced lysis (untreated septal and auricular hematomas)
bilateral: mumps
recent surgery, DM, dry mouth/dehydration; Staph most common
submandibular
The Fort classification - describe 1,2&3
concerns of associated injuries/complications (3)
I - Horizontal maxillary fracture
•Free-floating upper alveolar process
II - Pyramid fracture
•Free-floating mid-face (maxilla, nose, cheeks)
III - Upper jaw, nose and lateral orbits (zygoma)
Concerns: C-spine, airway, CSF rhinorrhea
Cavernous sinus thrombosis
Cavernous sinus thrombosis
clinical triad
symptom categories (3)
diagnosis (1 or 1)
ENT infection, venous congestion, ophthalmoplegia
swelling (facial edema, ecchymosis, proptosis)
cranial nerve palsy’s (3 through 6, 6 most common)
pupillary dysfunction - mydriasis from cranial nerve three
MRI or CT
Significance of this relationship
Proximity of the parotid duct and facial nerve
A vertically oriented laceration posterior to the corner of the eye and bisecting a line drawn from the tragus of the ear to the center of the upper lip can involve both the facial nerve and the parotid duct
Ludwig’s angina-organism category
pictured entity
etiology (2)
risk factors
treatment
Mixed aerobic and anaerobic
acute necrotizing ulcerative gingivitis (ANUG)
spirochetes and fusobacteria
young adult, poor oral hygiene, HIV
metronidazole, clindamycin
Pictured entity
common causes (4)
cervical lymphadenopathy cause categories (3)
Gingival hyperplasia
leukemia, phenytoin, cyclosporine, calcium channel blockers
categories
primary infection-cervical adenitis, staph or strep
response to local infection or systemic process (sarcoid, TB, Cancer)
Pictured entity
cause/natural history
agent
Lemierre’s syndrome
strep pharyngitis complicated by fusobacterium necrophorum ->
septic thrombophlebitis of the internal jugular vein ->
septic emboli too lung
child/infant Odynophagia + duck like voice + torticollis =
risk factor mechanism
Retro pharyngeal abscess
fall with stick/pencil in mouth
Retro pharyngeal abscess
Pictured entity
etiology of pictured findings
reason for virulence
treatment (2)
Diphtheria
pseudo-membrane is actually necrosis from exotoxin
bull neck is from severe cervical lymphadenopathy
because of multi-organ failure heart, CNS, kidneys, liver
antitoxin plus antibiotics (PCN/erthromycin)
Pictured entity
treatment (2)
similar to croup but more severe, likely illness
usual cause/natural history
Epiglottitis
ceftriaxone, Heliox
bacterial tracheitis
bacterial superinfection of preceding viral infection - staph, strep, age for
Croup
most common agent
albuterol?
Trismus causes (4)
Parainfluenza virus
no
DATE: dystonia, abscess, tetany (tetanus, hypocalcemia), epiglottitis
Leukoplakia
describe
similar condition and difference
evaluation
aphthous ulcer treatment options (3)
White plaque similar to candidiasis but cannot be scraped off
precancerous (esp in smoker)
biopsy
topical steroid/benzocaine/abx rinse/amlexanon (immunomodulator)
cause: cell-mediated immunity to unknown trigger
Gingivostomatitis
agent, treatment
contrast to herpangina (agent, location)
HSV1-2, acyclovir type; lesions anywhere including lips
herpangina: Coxsackie (and others), spares tongue, buccal mucosa, gingiva
Irreversible vs reversable pulpitis - temperature and tx differences
Pericoronitis - what
alveolar osteitis - what, tx (4)
Irreversible worse with hot (vs cold), needs antibiotics
, inflammation around malerupted 3rd molars
localized osteomyelitis after extraction, very painful
anesthesia, irrigate, pack, antibiotics, refer
Tooth avulsion
storage
treatment
survival rate over time
Milk or saliva rapid reimplantation (of adult teeth only),
survival: 1% less every minute
Neck masses by age (incomplete list)
infant (3)
child (3)
Young adult (4)
Adults
infant: hemangioma, lyphangioma + child causes
child: lymphadenopathy, branchial cleft cyst (lateral), thyrogloassal duct (central)
Young adult: mono, LAD, cysts, Hodgkins
Adults: 75% > 6 weeks = cancer
Facial nerve palsy
causes (5)
treatment
Ramsay-Hunt = cause
additional findings compared to Bells (2-3)
additional tx compared to Bells
Bells (idiopathic), Ramsey Hunt/HSV, Herpes simplex, otitis, Lyme disease
bells = steroids (“not both”)
zoster of the geniculate ganglion
involvement of taste, hearing loss/tinnitus/vertigo
vesicles in the ear canal, tongue, hard palate or face
do use acyclovir in addition to steroids
Zoster ophthalmicus
what
Hutchinson’s sign and significance
treatment (2+)
cause of dendritic lesions
Zoster of the V1 nerve -> eye involvement; can lead to keratitis, iritis, glaucoma
Hutchinson’s sign: involvement of the nasaoiliary branch -> tip of nose involved, reliably predicts site threatening etiology
steroids, antiviral, ophthalmology
dendritic lesions: can be Zoster ophthalmicus OR herpes simplex; these are different entities
Angioedema
hereditary form pattern, cause and treatment
Autosomal dominant, C1 inhibitor deficiency, FFP (has C1 inhibitor)
Post-tonsillectomy bleeding
treatment (action/agents)
Quincke syndrome - what, cause categories (2), tx
Direct pressure with forceps/gauze coated with thrombin, epi, lidocaine
isolated angioedema of uvula
same causes as angioedema + infection
dexamethasone
Neck zones
