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Phase II Decks > ENT > Flashcards

ENT Flashcards

1
Q

Cerumen impaction 3 recommended therapeutic options

A

Cerumenolytics, Irrigation, and Manual removal by clinician

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2
Q

How are cerumenolytics used

A
  • Avoid if TM damage
  • Do not exceed 3-5 days
  • can cause Allergic rx, Otitis externa, earache, Transient HL Dizziness
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3
Q

How is irrigation used

A

Warm water/saline 1:10 hydrogen peroxide

Tip of syringe should not pass lateral 1/3

Post and upward, follow w/ water and 2% acetic acid or boric acid

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4
Q

Foreign bodies

A

No irrigation for organic material

Immobilize insects w 2% Lidocaine
(kills insect and anesthetizes skin

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5
Q

Otitis Externa Main organisms that cause infx

A

P Aeruginosa and Staphylococcus Aureus MC

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6
Q

Mild AOE Tx

A

Drying Agent 50/50 mixture Isopropyl Alcohol/ Vinegar

2% acetic acid (Vosol) 5 gtts in canal TID-QID

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7
Q

P Aeruginosa and Staphylococcus Aureus readily grow in what pH

A

6.5-7.5

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8
Q

Moderate AOE Tx

A

Polymixin B/Hydrocortisone

(Potent sensitizer: Neomycin) for Pruritis erythema edema

Amynoglycosides: (Gentamycin)Ototoxic

Quinolones: Ofloxacin 10 gtts X1 daily X 7 days

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9
Q

Cellulitis, diabetes Immunodeficiency, Severe AOE, significant edema inhibiting application TX

A

Combo Ototopical and Systemic PO (No water sports X 10 days)

Cipro 500mg PO BID X 7 days P. aero and S. Aureus

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10
Q

Severe bacterial infection of External Auditory Canal EAC; MC Diabetics and Immunocompromised

A

Necrotizing Otitis Externa (Malignant Otitis externa)

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11
Q

MC cause of Necrotizing Otitis Externa?

A

Pseudomonas Aeruginosa

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12
Q

MC cause of Necrotizing Otitis Externa MC S/S?

A

Deep otalgia, EAC Granulation, Foul otorrhea, CN Palsies

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13
Q

What cranial nerve palsies does Necrotizing Otitis Externa affect?

A

VI, VII, IX, X, XI, XII

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14
Q

Necrotizing Otitis Externa TX?

A

I.V Cipro X several months

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15
Q

Pedunculated bony EAC lesion, benign osseus neoplasms attached to Tympanosquamous/mastoid suture line

A

Osteoma

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16
Q

Multiple EAC lesion, firm , bony, broad-based lesion

composed of lamellar bone reactive bone formation

A

Exostoses (Surfer’s ear)

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17
Q

MC neoplasm of ear canal

A

SCC TX resection 5 year mortality

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18
Q

MC cause of this is Viral URIs and allergies.

Acid reflux, Pregnancy 3rd Trimester, Down’s, Turners Adenoids and Cleft palate

A

Dilatory ETD

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19
Q

MC Cause of this is Neuro muscular disorders, High estrogen, OCPs prostate cancer, Scarring weight loss > 6lbs

A

Patulous ETD

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20
Q

Dilatory ETD Tx

A

URI, Allergic rhinitis- Decongestant/Antihistamine

GERD- PPI 2nd smoke cessation

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21
Q

Patulous ETD TX

A

Reassure, hydrate and NS spray, Sx, TM tubes

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22
Q

Prolonged ETD with Neg. middle pressure causes this

A

Serous Otitis Media

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23
Q

Serous Otitis Media s/s

A

Middle ear fluid presence without Acute S/S of illness or inflammation

CHL, Aural fullness reduce TM mobility, bubbles

Tympanometry Best dx

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24
Q

Suspect nasopharyngeal carcinoma when

A

Adult persistent unilateral Serous Otitis Media

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25
Q

Serous Otitis Media Tx?

A

Observation X 3 months if HL is mild; frequent Valsalva may be effective meds if indicated

PET if measures fail

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26
Q

Indications for PE Tubes

A

Severe or recurrent AOM

  • HL> 30 db -Chronic retraction ETD
  • Autophony (Patulous) (Stay 6-18 mths)
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27
Q

AOM Risk Factors

A

Pacifiers, bottle feeding, Day care, 2nd hand smoke

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28
Q

AOM Dx?

A

Erythema, decreased TM mobility, bulging, TM w/o landmarks, Bullae

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29
Q

Most common organisms cause AOM

A

Catarrhalis, H. Influenza, Pyogenes, “#1 S. Pneumoniae”

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30
Q

AOM Tx patient

A

<2 yo
>102.2 fever
No improvement in 48-72 hrs

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31
Q

AOM Tx 1st line?

A

1st Line Amoxicillin 80-90 mg/kg/day xx10 days

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32
Q

AOM Tx 2nd Line

A

Amox-clavunate 20-40 mg/kg/day X 10 days

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33
Q

AOM PCN Allergy

A

Cefdinir 300mg BID, Ceftriaxone 2G IM

Erythromycin + sulfanomide X 10 days

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34
Q

Amoxicillin, Ampiccillin or PCN rash =

A

MONO

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35
Q

AOM at 2 weeks ______ Pts will have fluid in their ears

A

50%

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36
Q

AOM at 10 weeks ______ Pts will have fluid in their ears

A

10%

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37
Q

Recurrent otitis media = TX PE Tubes

A

> = 3 distinct episodes in 6 months

> =4 distinct episodes in 12 months

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38
Q

Chronic Otitis Media essential dx

A

Chronic Otorrhea w/ Otalgia (Hallmark; Purulent DC)

TM perforation w/ CHL

Amenable Sx correction

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39
Q

AOM becomes COM in

A

2 weeks- 3 months

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40
Q

COM organisms

A

P. Aeruginosa, S. Aureus, Proteus

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41
Q

COM Tx?

A

Topical Ofloxacin/ Cipro w Dexamethasone
Cipro PO 500 mg BID X 1-6 weeks

SX repair / Mastoidectomy

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42
Q

COM complications

A

Cholesteatoma -TM perforation
Mastoiditis - Facial Paralysis
CNS infx

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43
Q

Most TM heal spontaneously when

A

< 25% surface

Persist > 6 weeks= ENT

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44
Q

3 layers of the TM

A

Squamous
Collagen Fibrous- Stops growing = Chronic TM perf.
Cuboidal Layer

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45
Q

D/O due to Prolonged ETD w negative middle ear pressure draws the upper flaccid portion inwards of TM

Erosion of inner ear can occur involves CN VIII

A

Cholesteatoma (Pars Flaccida)

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46
Q

Mastoiditis TX

A

IV ABX Cefazolin (0.5-1.5 G ever 6-8 hrs

MC S. Pneumoniae, H Influenza S. Pyogenes

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47
Q

Petrositis Triad (Gradenigo Syndrome)

A

Retro orbital pain
AOM
Abducens Paresis (CN-VI)

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48
Q

Ear Barotrauma prevention meds

A

Pseudoephedrine 60-120 mg several hrs prior to descent

Oxymetazoline (Afrin) 1 hrs prior to descent

Chew gum, Valsalva, swallow

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49
Q

Barotrauma referral to ENT when

A

Severe otalgia, HL, VErtigo, persistent > 4-5 days or blast injury

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50
Q

TM Perf TX if

A

(+) Infx Signs
(+) HL

Otherwise f/u in 2-3 mths

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51
Q

Pulsatile Tinnitus + CHL =

A

Middle ear neoplasia + MRI

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52
Q

Peripheral Vertigo Cause

A

80% , typically not serious, S/S severe

X3 MC BPPV, Meniere’s , Vestibular neuritis

53
Q

Central Vertigo cause

A

20% case, Mild and discrete, brainstem cerebellar

MC Vestibular migraine and Vascular etiologies or Multiple Sclerosis

54
Q

Uses electrodes to record eye movements

A

Electronystagmography

55
Q

Uses video cameras to record eye movements

A

Videostagmography

56
Q

Vestibular ocular reflex or nonvestibular

A

Caloric Stimulation

COWS Cold-Opposite Warm same

57
Q

Sudden onset lasting less than 1 minute triggered by change in head position NO HL

A

Benign Paroxysmal Positioning Vertigo

58
Q

BPPV DX

A

Dix-Hallpike Maneuver- Nystagmus and vertigo w/in seconds and last 30 seconds

59
Q

BPPV TX

A

Epley’s Maneuver

60
Q

Episodic Vertigo Lasting from 20 min. to several hours

SNHL w Lower frequencies- Blowing tinnitus, Unilateral aural fullness

A

Endolymphatic Hydrops (Meniere’s)

61
Q

Endolymphatic Hydrops Dx

A

Caloric Testing and SHL Audiometry

2ndary distention of the endolymphatic space

62
Q

Endolymphatic Hydrops TX

A

Oral meclizine Diuretics (Acetazolomide)

Vestibular rehab Exercises

Low salt diet, caffeine, nicotine Alcohol

refractory: Intratympanic corticosteroids inj.
Vestibular ablation, labyrynthectomy

63
Q

Endolymphatic Hydrops two known causes

A

Syphilis and Head trauma

64
Q

Acute onset of persistent and severe vertigo days-weeks Nausea / Vomiting

Follows Viral Infx, awakens w room spinning

A

Vestibular Neuritis (Hearing preserved)

Labyrinthitis (Transient Unilateral SHL)

65
Q

Vestibular Neuritis (Hearing preserved) Dx

Labyrinthitis (Transient Unilatera

A

Positive head trust, suppressed w visual fixation

66
Q

Vestibular Neuritis (Hearing preserved)

Labyrinthitis (Transient Unilateral SHL) TX

A

Vestibular therapy rehab exercises

Benzos and Meclizine

67
Q

Progressive or sudden unilateral SNHL

Continuous disequilibrium

A

Acoustic neuroma (Vestibular schwannoma)

Involves cerebellopontine Angle (MRI)*
Nerve Sheath CN VIII tumor

68
Q

Presents w/ s/s identical to Meniere’s inflammatory and degenerative for CNS episodic vertigo and chronic imbalance]

SHL rapid onset and unilateral, facial numbness, Diplopia

A

Multiple Sclerosis

69
Q

Typically elderly w arteriosclerosis, triggered by posture changes or extension of neck

Vertigo w brainstem deficits

A

Vertebrobasilar insufficiency

Tx Vasodilator and aspirin

70
Q

SNHL MC Cause

A

Presbycusis age related

Noise trauma > 85 DB injury cochlea

71
Q

Ototoxicity

A

Aminoglycosides neomycin gentamycin, loop diuretics, antineoplastic agents

72
Q

Hereditary Loss FMHX

A

Connexin-26 mutation MCC genetic deafness

73
Q

Staccato tinnitus means

A

Clicking tinnitus

74
Q

Acute Viral rhinorrhea

A

clear rhinorrhea, hyposmia, congestion, erythematous mucosa S/S < 4weeks typically <10 days

75
Q

Acute viral rhinorrhea Tx

A

Zinc 75 mg, sudafed 30-60 mg q 4-6 hrs,

Oxymetazoline no > 3 days

76
Q

Acute Bacterial rhinosinusitis

A

Purulent yellow- green DC or expectoration 3-4 days

Nasal congestion Facial pain over sinuses 3-4 days

Tooth pain: persistent> 10 days, fever 102, worsening s/s

77
Q

Subacute Bacterial sinusitis

A

4-12 weeks

78
Q

Acute bacterial Sinusitis

A

<4 weeks

79
Q

Chronic sinusitis

A

> 12 weeks

80
Q

Recurrent sinusitis

A

X4 in 1 year

81
Q

Bacterial Sinusitis TX

A

< 10 days NSAID, decongestant, ICS

ABX: 102 fever> 10 days worsening Augmentin 875
PCN Allergy Doxy 7-10 days

82
Q

Nasal Vestibulitis S Aureus

A

Dicloxacillin 7-10 days Mupirocin/Chlorhexidine BID 5 days

83
Q

Rhinocerebral Mucormycosis

A

Aspergillus in DM, Aids, Corticosteroid use prolonged

Black Eschar middle turbinate, silver stains

Tx: Amphotericin B (Kidney dz= Mortality >50%)

84
Q

Allergic rhinitis

A

Clear rhinorrhea, Sneezing teary eye, pruritus pale violaceous turbinates, cobblestoning post pharynx

TX: ICS 2 week delay tx

85
Q

Septal hematoma check

A

Infraorbital rim step-off, Infraorbital numbness, and Septal hematoma (Clot between perichondrium and septum)

–> septal necrosis –> Saddle -nose deformity

86
Q

Nasal trauma reduction w/in

A

Closed reduction w/in 1 week

Anti Staph ABX cephalexin QID, Clindamycin QID

87
Q

Malignant Nasopharyngeal Paranasal Sinus Tumors

A

Unilateral =SCC MRI

88
Q

Blood stained crust and friable mucosa: Bx= Necrotizing granulomas and vasculitis

Multisystem granulomatous D.O involves sinuses

A

Granulomatosis w/ Plyangiitis (Wegener’s) Sarcoidosis

(Wegener’s rare blood disease90% nose involvement

89
Q

Chronic waxing and waning inflammatory condition

White lacy striations (Wickham’s Striae) or papules on mucosa (No pain)

A

Oral Lichen Planus

Tx: = Manage pain and discomfort

90
Q

Oral candidiasis X 2 forms

A

Pseudomembranous (MC)

Atrophic form AKA denture stomatitis

91
Q

Oral candidiasis Infants

A

Clean bottles nipples and pacifiers boiled

Nystatin Suspension Applied w/ swab X2weeks: continued until 2-3 days after resolution

Refractory: Gentian violet oral fluconazole

92
Q

Children Tx Mild candidiasis

A

< 50% mucosa involved: Topical Nystatin or clotrimazole X7-14 days

Nystatin suspension swished in mouth long as possible QID Lozenges 10 mg 5-6 times daily

93
Q

Children Candidiasis Tx severe

A

> 50% mucosa

Fluconazole 6 mg/kg X1 1st day: 3 mg/kg q day X 7-14 days

94
Q

Tx Adults candidiasis

A

Fluconazole 100 mg PO X 7days

Ketoconazole 200-400 mg 7-14 days

Nystati rinses 5ml long as possible swallow
Chlorhexadine or H2O2 rinses (Nystatin powder dentures)

95
Q

Recurrent Aphthous Ulcer Tx

A

Triamcinolone of Fluocinonide or Diclofinac

Oral prednisone 60 mg X 1 week taper

96
Q

Inflammatory D/O that leads to atrophy of the papillae

A

Atrophic Glossitis

Smooth glossy tongue: B12, iron folate deficiency
Sjogren disease Protein calorie malnutrition

Burn sensation with salty and citrus foods

97
Q

Tongue lesion associated with Downs Syndrome

A

Fissured Tongue

98
Q

Black tongue is cause by what medications

A

Bysmuth Subsalycilate, Tetracyclines, PPIs, Antidepressants

99
Q

Affects epithelium of tongue–> ulcer like lesions: Lesions can change location and pattern in minutes

Associated wit?

A

Geographic Tongue : Candidiasis, psoriasis, Reiter’s , Lichen planus

100
Q

Centor criteria if present Pharyngitis/Tonsilitis

A

Fever > 100.4
Anterior cervical LAD
Cough Absent
Exudate present on tonsils 3/4 present = 90%

101
Q

Heterophile Auto Ab

A

Mononucleosis (Palatal petechiae and shaggy white purple tonsillar exudate

102
Q

Group A Beta Hemolytic Strep TX

A

PCN VK 500 mg BID X 10days (250 mg Children<27kg)

PCN Allergy= Azythromycin 500 mg X 3days
(12mg/kg Qd X 5 days Children

103
Q

Peritonsillar abscess Tx

A

Cellulitis w/o Airway compromise, septicemia, Trismus
= IV ABX cover GABHS

No Airway S/S- W fever, trismus voice change, uvula deviation= Aspiration + Admit + Abx, hydrate analgesia

Tonsillectomy I and D no response in 24 hrs

104
Q

Recurrent tonsillitis for tonsillectomy?

A

Watchful waiting if < 7 episodes in 12 months
<5 episodes in 2 years
<3 episodes a year in past 3 year

105
Q

Tx of Parotitis

A

Hydration and IV ABX Nafcillin + metronidazole or Clinda

106
Q

Sialolithiasis MC

A

Wharton Duct

2< cm from duct opening= Sialogogues, warm fluids, massage, the dialate or incise

> 2 cm from duct opening= Sialoendoscopy

107
Q

Salivary gland tumor

A

80% in parotid gland (adenoid cystic carcinoma)

Malignancy concern if CN VII affected

108
Q

Most common neck space infection. BL infection of the submandibular space.

Tongue pushed back, may obstruct airway

A

Ludwig’s Angina

109
Q

Ludwig’s Angina MC Cause

A

Dental infection

110
Q

Thrombophlebitis of the internal jugular vein secondary to oropharyngeal inflammation

Typically ICU pts prolonged Internal Jug vein

A

Lemierre Syndrome

111
Q

Ludwig’s Angina MC bugs

A

Streptococci and staphylococci

112
Q

Ludwig’s Angina Tx

A

Penicillin + Metronidazole

Ampicillin sulbactam

(Deep neck + InD IV Abx Intubate tracheotomy

113
Q

Lemierre syndrome Abx cover organisms

A

Fusibacterium Necrophorum

114
Q

Painful enlargement of lymph nodes: Infection

MC cause of neck mass of all age groups

A

Reactive cervical LAD

Tx FNA >1.5 cm >40 R/O cancer

115
Q

Cat scratch disease

A

Bartonella Henselae Single node enlarged

116
Q

Toxoplasmosis Gondii

A

OOcytes in cat feces Single enlarged node posterior triangle

117
Q

Lyme disease

A

Borrelia Burgdorferi Ticks

75% head involved Facial Paralysis, Distorted taste,

118
Q

Scores > 10 considered abnormal excessive daytime sleepiness. Range 0-24

A

Epworth Sleepiness Scale

119
Q

Foreign Body in children Tx

A

Bronchoscopy

50% non sharp will pass in stool

120
Q

MC congenital masses of lateral neck. Typically soft slow growing and painless. Anywhere along SCM m.

Not midline does not move with swallowing

A

Branchial Cleft Cyst

TX excise w fistoulous tract

121
Q

MC Congenital mass of the central neck. Remnant occurring along the embryologic thyroid descent

Contains thyroid tissue Carcinoma reported

Midline below hyoid moves w swallowing

A

Thyroglossal Duct Cyst

TSH if abnormal: US confirm position of thyroid

Tx Removal with tract

122
Q

Head an neck cancer get

A

triple endoscopy Laryngo/Broncho/Esophago- scopy

MRI or PET

123
Q

Multiple rubbery nodes =

A

Lymphoma (Hodgkin’s non Hodgkin’s)

124
Q

Thyroid cancers

A

Papillary-Slow 80%
Follicular- More aggressive 10%
Medullary- FNA dx, Iodine poor uptake men2A 5%
Anaplastic-Most aggressive <2 %

125
Q

Leakage of peri lymphatic fluid from the inner ear to the tympanic cavity via the round/oval window due to..

Extreme barotrauma, hand-slap to ear trauma, vigorous Valsalva extreme weight lifting

A

Peri lymphatic Fistula

126
Q

frequently assoc. w migraine headache w/o associated hearing loss or tinnitus.

head pressure- visual, motion or auditory sensitivity.

A

Migrainous Vertigo

127
Q

Amongst the MC intracranial tumors. Most unilateral w unilateral HL

Any individual w/ Unilateral HL should be evaluated for Intracranial mass lesion DX MRI

A

Vestibular schwannoma (Acoustic Neuroma)

128
Q

Common cause of vertigo in the elderly triggered by changes in posture or extension of the neck

A

Vertebrobasilar insufficiency

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