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EM Board exam > ENT > Flashcards

ENT Flashcards

1
Q

Sudden sensorineural hearing loss (SSHL)

timing, bilateral/unilateral?
most common cause + other categories

associated symptoms (2)
possible workup (3)

treatment (3)

A

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

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2
Q

Sudden sensorineural hearing loss (SSHL)

most common drug causes (4)

A

Loop diuretics (furosemide), salicylate, aminoglycoside, neomycin, vancomycin

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3
Q

Pictured disease
most common etiology
pathogmnemonic distribution

common cause

A

Perichondritis

Post traumatic (esp ear piercing)

spares pinna
Pseudomonas

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4
Q

TM perforation

natural history

early referral indications (2)

abx?

Infected tympanostomy tubes tx

A

Spontaneous healing
traumatic mechanism or posterior location
only if mechanism was forced water entry

ciprodex drops superior to oral abx

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5
Q

Otitis media

most common bacterial causes (1+2)

pictured disease
most common cause
treatment (2)

A

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

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6
Q

Pictured disease
cause/findings (2)

Tx

A

Cholesteatoma

  • Keratin-producing squamous epithelium overgrowth in the middle ear
  • Often foul-smelling drainage

surgery

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7
Q

Dix-Hall-Pike

sensitivity for BPV
positive test =

vestibular neurontis vs labyrinthtis key differences - cause and sx

A

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

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8
Q

Meniere’s disease

cause

sx and pattern

tx (3)

A

Excess endolymph

paroxysmal tinnitus, vertigo, hearing loss -> progressive episodes (2-8h) and symptoms

low-salt diet, diuretics, steroids

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9
Q 
Ototoxic drugs
irreversible damage (3)

other common reversible causes (3)

Ramsay-Hunt =

A

irreversible: aminoglycosides, cytostatic, loop diuretics
reversible: NSAIDs, quinolones, antimalarials, erythromycin

Ramsay-Hunt = VZV affecting head/neck nerve, most commonly VII

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10
Q

Central vertigo causes (4)

A

Cerebellar/brainstem infarct or hemorrhage

vertebrobasilar insufficiency

MS (look for associated ataxia, optic neuritis)
basilar migraine

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11
Q

Sinusitis-causes (4)

complications of posterior pack (4)

CSF rhinorrhea antibiotics?

A

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

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12
Q

Cauliflower ear and saddle-nose deformity: mechanism

salivary gland problems

bilateral parotitis cause

bacterial parotitis risk factors, common cause

siaolodenitis: location 80%

A

destruction of cartilage by blood-induced lysis (untreated septal and auricular hematomas)

bilateral: mumps

recent surgery, DM, dry mouth/dehydration; Staph most common

submandibular

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13
Q

The Fort classification - describe 1,2&3

concerns of associated injuries/complications (3)

A

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

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14
Q
A
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15
Q
A
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16
Q
A
17
Q

Cavernous sinus thrombosis

A
18
Q

Cavernous sinus thrombosis

clinical triad

symptom categories (3)

diagnosis (1 or 1)

A

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

19
Q

Significance of this relationship

A

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

20
Q

Ludwig’s angina-organism category

pictured entity
etiology (2)

risk factors
treatment

A

Mixed aerobic and anaerobic

acute necrotizing ulcerative gingivitis (ANUG)

spirochetes and fusobacteria

young adult, poor oral hygiene, HIV
metronidazole, clindamycin

21
Q

Pictured entity
common causes (4)
cervical lymphadenopathy cause categories (3)

A

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)

22
Q

Pictured entity

cause/natural history

agent

A

Lemierre’s syndrome
strep pharyngitis complicated by fusobacterium necrophorum ->

septic thrombophlebitis of the internal jugular vein ->

septic emboli too lung

23
Q

child/infant Odynophagia + duck like voice + torticollis =

risk factor mechanism

A

Retro pharyngeal abscess

fall with stick/pencil in mouth

24
Q
A

Retro pharyngeal abscess

25
Q

Pictured entity

etiology of pictured findings

reason for virulence
treatment (2)

A

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)

26
Q

Pictured entity
treatment (2)

similar to croup but more severe, likely illness
usual cause/natural history

A

Epiglottitis
ceftriaxone, Heliox

bacterial tracheitis
bacterial superinfection of preceding viral infection - staph, strep, age for

27
Q

Croup

most common agent

albuterol?

Trismus causes (4)

A

Parainfluenza virus
no
DATE: dystonia, abscess, tetany (tetanus, hypocalcemia), epiglottitis

28
Q

Leukoplakia

describe

similar condition and difference

evaluation

aphthous ulcer treatment options (3)

A

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

29
Q

Gingivostomatitis

agent, treatment

contrast to herpangina (agent, location)

A

HSV1-2, acyclovir type; lesions anywhere including lips

herpangina: Coxsackie (and others), spares tongue, buccal mucosa, gingiva

30
Q

Irreversible vs reversable pulpitis - temperature and tx differences

Pericoronitis - what

alveolar osteitis - what, tx (4)

A

Irreversible worse with hot (vs cold), needs antibiotics

, inflammation around malerupted 3rd molars

localized osteomyelitis after extraction, very painful

anesthesia, irrigate, pack, antibiotics, refer

31
Q

Tooth avulsion

storage
treatment

survival rate over time

A 
Milk or saliva
rapid reimplantation (of adult teeth only),

survival: 1% less every minute

32
Q

Neck masses by age (incomplete list)

infant (3)

child (3)

Young adult (4)

Adults

A

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

33
Q

Facial nerve palsy

causes (5)
treatment

Ramsay-Hunt = cause

additional findings compared to Bells (2-3)

additional tx compared to Bells

A

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

34
Q

Zoster ophthalmicus

what
Hutchinson’s sign and significance
treatment (2+)

cause of dendritic lesions

A

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

35
Q

Angioedema

hereditary form pattern, cause and treatment

A

Autosomal dominant, C1 inhibitor deficiency, FFP (has C1 inhibitor)

36
Q

Post-tonsillectomy bleeding

treatment (action/agents)

Quincke syndrome - what, cause categories (2), tx

A

Direct pressure with forceps/gauze coated with thrombin, epi, lidocaine

isolated angioedema of uvula
same causes as angioedema + infection

dexamethasone

37
Q

Neck zones

A

EM Board exam (18 decks)

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