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Specialty Care > ENT > Flashcards

ENT Flashcards

1
Q

How do you determine AOM v. OM w/ Effusion?

A
  • 1- Is there an effusion?
    • Blue, white, yellow, amber color
    • Opacity
    • Dec mobility of TM
  • 2 - Is there inflammation? (if so, AOM)
    • Red (mainly injection) - poor specificity
    • Bulging (look at relationship to short process of malleus and the annulus)
    • Sx - ear pain
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2
Q

What physical exam components should be performed for vertigo?

A
  • Orthostatics - look for systolic dec > 25 mmHg
  • Dix - Hallpike
  • Watch pt walk without their awareness
  • Ear exam - signs infection or growths
  • Neuro exam - esp CN, Romberg, cerebellar testing
  • Meas vestibular-ocular reflex by asking them to read Snellen chart while shaking head no - should be able to read if reflex intact
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3
Q

Meniere’s Disease

A
  • 1- vertigo
  • 2- change in vision w/ tinnitus
  • 3- fullness in ear

Tx = low Na diet, K sparing diuretics to decrease endolymph; may need surgical drainage of endolymph sac or ablation / chemical ablation of labyrinth w. gentamicin

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4
Q

BPPV (sx and tx)

A

Benign Paroxysmal Positional Vertigo (#1 cause vertigo)

Sx = Nystagmus & positive Dix-Hallpike

  • Particles most often in posterior canal b/c inferior when upright
  • Positional change –> particles move –> brain thinks you are moving –> eyes move (nystagmus)
  • Tx = Epley Maneuver
    • Start w/ Dix-Hallpike on symptomatic side - WAIT 30 sec - rotate 270 degrees until nose down - sit patient up
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5
Q

Dix-Hallpike

A
  • Head turned 45% to affected side w/ chin up in seated position; then lay back
  • If positive will see period of latency followed by up-beat nystagmus
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6
Q

Vestibular Neuronitis

A
  • Acute presentation is spinning and vomiting for days; often associated w/ URI sx
  • Tx = IVF and vestibular suppressants temporarily; may have long term sequelae
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7
Q

What are 3 features of pre-syncope?

A

1- tunnel vision

2- lightheadedness

3- flushing / warmth

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8
Q

Disequilibrium (+ common causes)

A

Feeling off balance

CAUSES

- Presbystasis - w/ age
- Post-labyrinthitis vestibulopathy - long term sequelae
- Multi-Sensory
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9
Q

How do you generally treat dizziness?

A
  • Adjust medications - STOP vestibular suppressants

**Meclizine, dimenhydrinate (dramamine), Benzo, scopalamine, TCAs, perchlorperazine, droperidol, diphenhydramine (Benadryl), hydroxzine, etc

  • Rehabilitation and exercise
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10
Q

3 Indications for Tracheotomy

A
  • Bypass upper airway obstruction (ex - cancer)
  • In order to extubate (can take off sedation and stop throat/larynx irritation)
  • Remove aspirated secretions
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11
Q

Anatomical Considerations in Tracheotomy

A
  • Lower than cricothyroidectomy (between thyroid and cricoid cartilages)
  • Extend neck during surgery to move trachea more anteriorly
  • Skin - fat- strap muscles - anterior jugulars and thyroid gland nearby (may have to move it up or down or cut it)
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12
Q

If a tracheotomy is not suctioning what must you consider?

A
  • Trach may have moved to anterior mediastinum when adjusted –> then when vent you cause pneumomediastinum –> requires needle decompression in 2nd intercostal space
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13
Q

What is the number one thing to remember in someone with a laryngotomy?

A

DO NOT PLUG STOMA

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14
Q

Steps in Tracheotomy Decannulation

A
  • trade in for smaller tube and do trial with it plugged first; one-way inspiration only valve (Passy-Muir valve)
  • CANNOT HAVE CUFF INFLATED WITH VALVE
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15
Q

Weber Test

A
  • place fork on midline nose or forehead - LATERALIZE
  • If lateralizes to good ear = sensorineural problem
  • If lateralizes to bad ear = conductive problem
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16
Q

Rinne Test

A
  • compare bone of mastoid to air in front of ear)
  • If air > bone = normal
  • If bone > air = conductive (could also mean that patient is completely deaf in that ear and is really just hearing thru other ear when using bone)
17
Q

Sensorineural Hearing Loss (common presentation, causes, tx)

A
  • problem with inner ear (internal basilar membrane and cochlear nerve)
  • Usually occurs over 3 days or less, decrease in hearing by 30 decibels, loss across 3 consecutive frequencies
  • Causes - 90% idiopathic, drugs (cisplatin, gentamicin), trauma, noise, CVD (stroke), MS
  • Tx - oral prednisone + intra-tympanic steroid injections (best if given within 2 wks)
18
Q

How do you treat a sub-perochondrial hematoma?

A

Do I&D to drain –> dressing and abx; suture dental roll or gauze in place over ear

19
Q

Otitis Externa

A
  • Risk = Q tip use, hearing aids, eczema, DM, immune-comp, water and heat exposure
  • Prevention = 1:1 rubbing alcohol and white vinegar
  • Tx
    • 1- clean ear
    • 2- keep ear dry
    • 3- TOPICAL abx - ciprodex, floxin
    • 4- culture if not getting better
  • If chronic it may be fungal –> topical anti-fungal like Lotrimin or clotrimazole)
20
Q

Osteoma v Exostoses

A
  • Osteoma - bony and pedunculated; leave it unless obstructing ear canal
  • Exostoses - associated w/ cold water in ear (esp surfers); often bilateral and multiple per ear; also leave unless obstructing
21
Q

TM Perforation

A
  • Often secondary to infection or trauma
  • Sx = pain, dec hearing, aural fullness, tinnitus
  • No mobility on pneumo otoscopy because air goes right thru hole
  • Tx
    • If small, observe and spontaneous healing
    • If large, tympanoplasty
    • Keep dry to avoid infections
22
Q

Serous OM

A
  • fluid behind TM w/o infection
  • Risk = air travel, URI, nasopharyngeal mass, E tube dysfunction
  • Tx = nasal steroids or limited use of nasal decongestants, pop ears
  • If > 3 mo then myringotomy +/- tubes to relieve the negative pressure (equalize it) so that inner ear fluid can resorb
23
Q

How do you treat chronic suppurative otitis media?

A

give topical steroid (ciprodex) + topical abx

24
Q

Cholesteatoma

A
  • Keratin debris in middle ear (created by epithelial layer of TM)
  • Nidus of infection or causes erosion of ossicles (hearing loss), facial nerve (palsy), semicircular canals (vertigo)
  • Tx - surgical
25
Q

When should you work-up hoarseness?

A

If present > 2 weeks

26
Q

What is the #1 sign that a sinusitis is bacterial?

A

DURATION (7-10 days) or 2nd worsening

27
Q

What is associated with unilateral nasal discharge in kids?

A

Foreign body

28
Q

What should you think of in someone with normal ear exam but earache?

A

Referred pain from head and neck cancer

29
Q

How common is malignancy in neck lumps?

A

80% of adults (HPV most common)

30
Q

What is the work-up for dysphagia?

A

H&P

Modified swallow

31
Q

What is the work up of head and neck lump?

A
  • H&P
  • FNA
  • CT
  • Surgery to remove tonsils and biopsy tongue base To find primary tumor
  • OPEN BIOPSY

Specialty Care (5 decks)

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