ENT

Question 1

Epiglottitis symptoms

Answer 1

Caused by HIB

Tripod position or HYPEREXTENDED NECK!

Dysphagia, DROOLING, respiratory distress.

Develops very quick.. WITHIN SEVERAL HOURS without a significant prodrome.

Signs of impending airway –> MUFFLED hot potato voice, Restlessness, anxiety, worsening stridor.

X - ray = Thumb print sign

Management = Antibiotics / intubation

Question 2

Bronchiolitis symptoms

Answer 2

Lower resp tract (so no stridor)

Seen in patients less than 2 yo

Fever, Cough, Retractions, Crackles / Wheezing

Question 3

Significant Neck Edema + gradual onset of Sore throat, low grade fever + LARYNGEAL PSEUDOMEMBRANE.

Can lead to severe resp distress and stridor

Answer 3

diphtheria.

Question 4

Barky Cough + Stridor + Fever

Answer 4

Laryngotracheitis (CROUP)

Question 5

Continuous ear drainage for several weeks despite appropriate antibiotic therapy raises suspicion for what diagnosis?

Answer 5

CHOLESTEATOMA.

can be congential or acquired.

Chronic middle ear disease leads to the formation of a retraction pocket in the typmanic membrane, which can fill with GRANULATION tissue and SKIN debris.
“White mass) posterior to the tympanic membrane.

Complications - HEARING LOSS, cranial nerve palsies, vertigo, and potentially life threatening infections such as BRAIN ABSCESS or MENINGITIS.

Refer to an OTOLARYNGOLOGIST for a dedicated otologic exam, possibly accompanied by a CT and / or surgical visualization to confirm diagnosis.

Question 6

A solitary area of BONY overgrowth in the OUTER ear with possible hearing loss is what condition?

Answer 6

OSteoma - benign condition

Question 7

Bony Overgrowth of the STAPES FOOTPLATE that results in CONDUCTIVE HEARING LOSS

Answer 7

Otosclerosis

Question 8

What kind of hearing loss do Aminoglycocydies, Chemotherapytic agents, Aspirin and Loop diuretics create?

Sensorineural or conductive?

Answer 8

SENSORINEURAL!

Loops are associated with reversible or permanent hearing impairment, reversible deafness, and/or tinnitus.

Question 9

what are the most common causes of otitis externa?

Answer 9

P. Aeruginosa and S. Aureus

Treatment regimens include drugs with antipseudomonal activity –> Fluroquinolone drops.

Otitis externa = USE DROPS! not oral med.

Question 10

Dental infection + slow-growing, indurated mass that forms multiple sinus tracts to the skin and a purulent discharge with YELLOW SULFUR GRANULES.

What is the organism?

Answer 10

Actinomyces

Question 11

Oral Lekuoplakia

Answer 11

A reactive precancerous lesion that represents HYPERPLASIA of the SQUAMOUS EPITHELIUM.

Seen in patients that use SMOKELESS tobacco and also ALCOHOL use.

1-20 percent will progress to squamous carcinoma within 10 years.

most lesions resolve within a few weeks after cessation of tobacco use.

Question 12

Laryngomalacia.. what is the confirmatory test?

Answer 12

Its a clinical diagnosis. But if on the exam they ask for a confirmatory test then it is LARYNGOSCOPY.

Caused by increased LAXITY of the SUPRAGLOTTIC structures –> inspiratory stridor that is worse when supine. Peaks at age 4-8 months.

Treatment is usually just reassurance. Can do a suptralottoplasty for severe cases.

Spontanoeus resolution of stridor by age 18 months.

Question 13

Acute otitis media treatment?

Answer 13

Amoxicillin or amoxicillin-calvualnic acid

Diagnosis confirmed by OTOSCOPY showing middle ear infusion (indicated by poor tympanic membrane mobility)

Question 14

Tympanocentesis with culture or Tympanostomy + surgical tube placement is done when in Acute Otits Media??

Answer 14

It is done in children who take antibiotics yet still have multiple episodes of AOM (more than 3 in 6 months or 4 in 12 months)

Question 15

Diabetic with ear pain and drainage, GRANULATION TISSUE within the ear canal.. and FACIAL DROOPING.. what is the most likely causative organism.

Answer 15

P. Aeruginosa.

This is Malignant Otitis Externa… this will not be responsive to topical meds.

The facial droop is caused by damage to the facial nerve.

CT or MRI can be used to confirm the diagnosis.

Treatment is with SYSTEMIC antibiotics that are effective against PSEUDOMONAS.

Question 16

How do Rhizopus infections in diabetics present?

Answer 16

Seen in poorly controlled diabetes.

Begin in the PARANASAL sinuses and extend into the ORBIT and BRAIN.

Question 17

whistling noise post rhinoplasty?

Answer 17

Nasal septal perforation.

Question 18

Nasopharyngeal carcinoma is caused by reactivation of what virus?

Answer 18

EBV.

Endemic to china, Middle east.

when it spreads to adjacent tissue –> nasal congestion with EPISTAXIS.

When it spreads to the CERVICAL lymph nodes –> Nontender NECK MASS>

Question 19

What is the difference between Serous Otitis Media and Acute Otitis Media

Answer 19

Serous Otitis Media - does not have inflammatory signs (fever, tympanic membrane bulging).

The effusion may be asymptomatic and present in the weeks following Acute Otitis Media treatment, or if chornic can lead to hearing loss.

Question 20

ACL vs MCL tears

Answer 20

ACL - caused by rapid deceleratoin or pivoting at the knee with the foot planted. Acute HEMARTHROSIS is common in these injuries and may limit extension of the knee.

MCL tear - Caused by Severe VALGUs stress (blow to the lateral knee) or TWISTING injury. Ligamentous laxity may be masked in the acute phase by swelling and MUSCLE SPASM. Range of Motion is preserved.

Question 21

Meniscal tears

Answer 21

Occur from pivoting on a FLEXED KNEE while the foot is planted.

LOCKING, or CATCHING with range of motion. Small joint effusion.

Question 22

Infected Mandibular Molar –> causing Fever, Dysphagia, Odynophagia and DROOLING

Answer 22

Ludwig Angina –> a Rapidly Progressive BILATERAL cellulitis of the sumbandibular and sublingual spaces.. arising from an infected mandibular molar.

Question 23

What causes cavernous sinus thrombosis?

Answer 23

Contiguous spread of infection from the MEDIAL THIRD of the FACE, Sinuses, or TEETH via the VALVELESS facial VENOUS SYSTEM.

Clinical findings - Headache, Fever, Cranial Nerve Deficits, and PROPTOSIS.

Question 24

What is the treatment for Malignant Otitis Externa?

Answer 24

Unrelenting ear pain and Pururlent drainage with a sense of fullness and CONDUCTiVE HEARING LOSS on the affected side.

IV Antibiotics. We dont do surgical excision since we have anti pseudomonla antibiotics now. Surigcal debridment is done if patient fails the antibiotics.

CIPRO is drug of choice. But you can use any antipseudomonal drug!

Question 25

How do you distinguish Otitis Externa from Malignant Otitis Externa?

Answer 25

Severity of Pain, Presence of GRANULATION TISSUE!, Elevated ESR.. are all seen in MALIGNANT otits externa.

Question 26

Expanisle and Eccentric LYTIC area (sopa bubble) in DIAPHYSIS is suggestive of what tumor?

Answer 26

GIant CELL!

Question 27

What is the 1st step in treating osteoarthritis of the knee?

Answer 27

Exercise and weight loss.

Exercise –> STRENGTHEN THE QUADRICEPS MUSCLE.

If it persists after all this.. then next step is NSAIDs.. (acetaminophen can be an alternate)

If symptoms still persist:
Topical Nsaids or Intrarticular Glucocorticoids or Intrarticular Hyaluronic acid

If symptoms still persist:
Surgery
or Chronic pain management for non surgical candidates.

Question 28

Pain on the medial aspect of the knee just distal to the joint line. Which is exacerbated by pressure from the contralateral knee while lying on the side is seen in what condition?

Answer 28

Pes Anserinus Pain Syndrome (ANSERINE BURSITIS)

Treatment - place pillow between legs when lying down.

Question 29

What indicates an abnormal Rinne test

Answer 29

Normally Air Conduction > Bone conduction.

In an Abnormal rinne test: Bone conduction > Air conduction.

THis suggest CONDUCTIVE HEARING LOSS!

Question 30

Weber test

Answer 30

done by placing the vibrating tunning fork in the middle of the fore head. A normal person should hear the sound equally in both ears.

Patients with CONDUCTIVE hearing loss –> lateralize to the AFFECTED EAR (louder in the affected ear).

Patients with SENSORINEURAL hearing loss –> lateralize to the UNAFFECTED ear .. since the affected ear cannot sense the vibration.

Question 31

Common causes of conductive hearing loss

Answer 31

1. cerumen impaction
2. middle ear infection or fluid
3. decreased movement of the small bones of the ear
4. Bony tumors of the middle ear

Question 32

what kind of hearing loss do ototoxic antibiotics cause?

Answer 32

Conductive Hearing loss

Question 33

Trismus (Lock jaw) + fever, sore throat, difficulty swallowing + Muffled (hot potato) voice + UVULA DEVIATION (away from enlarged tonsil) + Pooling of saliva.

what is the diagnosis and treatment?

Answer 33

PERITONSILAR ABSCESS (Quinsy)

Treatment = Needle aspiration or INCISION to DRAIN! + Antibiotics (covering GAS and Resp anaerobes)

Question 34

Nasal congestion / CLEAR rhinorrhea, pale / edematous nasal mucosa + NASAL CREASES + PHARYNGEAL COBBLESTONING

Answer 34

Allergic Rhinitis

Treatment = avoid allergen + INTRANASAL GLUCOCORTICOIDS

will get some response from meds within a few hours.. but real results will be seen aftre days - weeks of use.

Question 35

What is the most common cause of CONDUCTIVE HEARING LOSS?

Answer 35

Repeat ear infections!

So if a child is showing signs of not responding to directions.. not acknowleding parents.. and they had a normal audiometry test… you may have to DO IT AGAIN, if they have had ear infections since the last audiometry test.

Question 36

What kind of hearing loss is present in MENIERES disease?

conductive or sensorineural?

Answer 36

SENSORINEURAL!

menieres disease has 3 things:

1. Tinnitus
2. Episodic Vertigo
3. Sensorineural Hearing Loss

Initiatl treatment for menieres is restriction of sodium, caffiene, nicotine and alcohol.

Benzos, antihistamies and antiemetics can be used to relieve acugte symptoms.

Long term managmeent –> diuretics.