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Clin Med II > ENT > Flashcards

ENT Flashcards

1
Q

Is the onset of peripheral or central vertigo more sudden?

A

Peripheral

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2
Q

Is peripheral or central vertigo associated with auditory symptoms?

A

Peripheral

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3
Q

What is the most important aspect of vertigo evaluation?

A

History

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4
Q

Is peripheral or central vertigo usually lessened with closed eyes?

A

Central

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5
Q

Is peripheral or central vertigo usually lessened with open eyes that are fixated on a nonmoving object?

A

Peripheral

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6
Q

About what types of brainstem symptoms would you inquire when trying to determine if the lesion causing vertigo is central or peripheral?

A
  • Diplopia
  • Facial numbness
  • Weakness
  • Hemiplegia
  • Dysphagia
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7
Q

What clinical tool can aid in the evaluation of spontaneous nystagmus by eliminating the factor of visual fixation?

A

Frenzel glasses

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8
Q

Describe the nystagmus that typically accompanies peripheral vertigo

A

-Usually horizontal with a rotary component

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9
Q

Describe the nystagmus that typically accompanies central vertigo

A

Any of the following:

  • Vertical
  • Bi-directional
  • Unilateral
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10
Q

MC cause of central vertigo

A

Drugs

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11
Q

Can the nystagmus that accompanies central or peripheral vertigo be suppressed by visual fixation on a nonmoving object?

A

Peripheral

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12
Q

What’s the most direct way of making the distinction between central and peripheral vertigo?

A

Ask about and evaluate brainstem symptoms

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13
Q

Vertigo caused by distention of the endolymphatic compartment of the inner ear

A

Meniere’s Disease

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14
Q

With what pathology are episodes of vertigo lasting minutes to hour associated?

A

Meniere’s Disease

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15
Q

With what pathology is the symptomatic triad of SNHL, tinnitus, and vertigo associated?

A

Meniere’s Disease

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16
Q

Describe the hearing loss associated with Meniere’s Disease

A
  • “Low tone dip”

- As the pressure builds up in the ear, hearing begins to decrease

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17
Q

Treatment of Meniere’s disease

A
  • Valium for severe vertigo
  • Low salt diet, diuretics
  • Intratympanic corticosteroid injections, endolymphatic sac decompression, and vestibular ablation
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18
Q

Vertigo caused by inflammation and swelling of the inner ear, though to develop as a consequence of a viral infection involving the cochlea and labyrinth

A

Acute Labyrinthitis

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19
Q

Patient presents with vertigo, tinnitus, and hearing loss. PMH significant for recent URI. Suspicion?

A

Acute labyrinthitis

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20
Q

Describe the duration of vertigo associated with acute labyrinthitis

A

Acute onset of continuous, usually severe, vertigo lasting several days to weeks

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21
Q

Vertigo associated with changes in head position

A

Benign positional vertigo

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22
Q

Describe the duration of vertigo associated with benign positional vertigo

A

-Recurrent spells of vertigo last seconds to minutes each time

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23
Q

How do you differentiate between acute labyrinthitis and vestibular neuronitis?

A

Vestibular neuronitis has no hearing loss since the cochlea is not involved

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24
Q

Describe the symptoms associated with Meniere’s disease

A
  • Hearing loss
  • Tinnitus
  • Vertigo lasting minutes to hours
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25
Q

Describe the symptoms associated with Acute labyrinthitis

A
  • Acute onset of continuous vertigo lasting days to weeks
  • Hearing loss
  • Tinnitus
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26
Q

Describe the symptoms associated with Benign positional vertigo

A

-Vertigo lasting seconds to minutes

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27
Q

Describe the symptoms associated with Vestibular neuronitis

A

Isolated vertigo lasting several days to a week with NO hearing loss

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28
Q

Treatment for vestibular neuronitis

A

Corticosteroids

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29
Q

Describe the symptoms associated with Vascular compression of the vestibular nerve

A
  • Disabling positional vertigo

- Severe nausea

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30
Q

What drugs are most injurious to the vestibular portion of CN VIII?

A

Streptomycin and Gentamycin

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31
Q

What’s the most worrisome peripheral cause of vertigo?

A

Vestibular schwannoma (AKA “Acoustic neuroma”)

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32
Q

Describe the symptoms of a vestibular schwannoma

A
  • Slowly progressive
  • ASYMMETRIC hearing loss
  • Tinnitus
  • Deteriorization of speech discrimination
  • Possible facial numbness/weakness
  • Vague vertigo
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33
Q

What pathology is associated with the following symptoms?

  • ASYMMETRIC hearing loss
  • Tinnitus
  • Deteriorization of speech discrimination
  • Possible facial numbness/weakness
  • Vague vertigo
A

Vestibular schwannoma

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34
Q

What is one of the earliest signs of vestibular schwannoma extension outside of the internal auditory meatus?

A

Decreased corneal reflex

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35
Q

What cause of vertigo is associated with constant, disabling positional vertigo?

A

Vascular compromise of the vestibular nerve

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36
Q

What might be the cause of vertigo lasting days to a week with no associated hearing loss?

A

Vestibular neuronitis

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37
Q

What might be the cause of vertigo lasting seconds to minutes associated with changes in head position?

A

Benign positional vertigo

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38
Q

Patient presents with a 1 week history of vertigo. PMH significant for a MVA 8 days ago. Suspicion?

A

Temporary head trauma vertigo

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39
Q

MCC of vertigo following a head injury

A

Labyrinthine concussion

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40
Q

Patient presents with vertigo after being kicked in the head during a recent mugging. You suspect temporary head trauma vertigo. Patient also has a slight hearing loss in both ears. What type of fracture should you suspect?

A

Basilar skull fracture

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41
Q

Leakage of perilymphatic fluid from the inner ear into the tympanic cavity via the round or oval window (pathology)

A

Perilymphatic fistula

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42
Q

Asthmatic patient recently sustained a head injury in a MVA. She complains of vertigo that seems to be worse when she coughs hard and a slight hearing loss. What do you suspect?

A

Perilymphatic fistula from a round/oval window rupture

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43
Q

Describe the symptoms that are associated with a perilymphatic fistula

A
  • Vertigo that’s worse with straining

- SNHL

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44
Q

Vertigo associated with dysfunction of the proprioceptors in the cervical neck that’s triggered by neck movements (Pathology)

A

Cervical vertigo

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45
Q

Patient sustains a whiplash injury in a MVA 1 week ago. Today he presents to your clinical because the had symptoms of vertigo after looking up at the stars the night before. What do you suspect?

A

Cervical vertigo

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46
Q

Causes of cervical vertigo

A
  • Neck injury (particularly hyperextension injuries)

- Degenerative spine disease

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47
Q

Describe the symptoms associated with cervical vertigo

A

-Vertigo that may be triggered by assuming a particular head position

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48
Q

Describe the (relevant) symptoms of multiple sclerosis (those relating to ENT)

A
  • Episodic vertigo and chronic imbalance
  • Hearing loss that’s commonly unilateral and of rapid onset
  • Slight facial numbness, Huskiness of the voice
  • Positional nystagmus
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49
Q

What pathology is associated with the following symptoms:

  • Episodic vertigo and chronic imbalance
  • Hearing loss that’s commonly unilateral and of rapid onset
  • Slight facial numbness, Huskiness of the voice
  • Positional nystagmus
A

Multiple sclerosis

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50
Q

Describe the symptoms that are often associated with vertebrobasilar insufficiency

A
  • Vertigo

- Other symptoms like diplopia, sensory loss, dysarthria, dysphagia, hemiparesis, and other brainstem deficits

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51
Q

What’s a good way to determine the difference between benign positional vertigo and vertebrobasilar insufficiency?

A

-Vertebrobasilar insufficiency will cause vertigo associated with brainstem symptoms, while benign positional vertigo is not associated with other symptoms

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52
Q

What types of drugs can cause central vertigo?

A
  • Sedatives
  • Antibiotics
  • Anticonvulsants
  • Analgesics
  • ETOH
53
Q

What type of x-ray shows the nasal bones the best?

A

Lateral head x-ray

54
Q

Hearing loss that results from dysfunction of the external or middle ear

A

Conductive hearing loss

55
Q

Hearing loss that results from deterioration of the cochlea, usually due to loss of hair cells from the organ of Corti

A

Sensorineural hearing loss

56
Q

Is most hearing loss due to disease of the cochlea symmetric or asymmetric?

A

Symmetric

57
Q

High frequency hearing loss

A

Presbyacucis

58
Q

Presbyacusis

A

High frequency hearing loss

59
Q

What’s the 2nd most common cause of SNHL?

A

Loud noise trauma

60
Q

Sounds over ______dB for prolonged exposure will cause permanent hearing damage

A

85

61
Q

What drugs cause IRREVERSIBLE ototoxicity?

A
  • Aminoglycosides
  • Loop diuretics
  • Antineoplastic agents
62
Q

Treatment of sudden sensory hearing loss

A
  • Prednisone

- Serial audiograms

63
Q

Is autoimmune hearing loss typically symmetric or asymmetric?

A

Symmetric

64
Q

Tx for autoimmune hearing loss

A

Corticosteroids

65
Q

CHL weber test

A

Sound lateralizes to the affected/worse ear

66
Q

SNHL Weber test

A

Sound lateralizes to the unaffected/better ear

67
Q

CHL Rinne test

A

Bone conduction > air conduction

68
Q

SNHL Rinne test

A

Air conduction > bone conduction, but it’s unequal on both sides

69
Q

Why is SOM more common in children?

A

Their eustachian tubes are narrower and more horizontal than adults

70
Q

What should you be thinking if you have chronic or unilateral serous otitis media in an adult with a history of smoking?

A

Tumor

71
Q

What are you required to do if you AOM in any neonate?

A

A workup for sepsis

72
Q

Most common cause of AOM

A

Strep pneumo

73
Q

Drug of choice for AOM

A

Amoxicillin/Augmentin

74
Q

Most common cause of otitis externa

A

Pseudomonas

75
Q

What kind of discharge would you expect to find in an otitis externa caused by Pseudomonas?

A

Green

76
Q

What kind of discharge would you expect to find in an otitis externa caused by Staph aureus?

A

Yellow

77
Q

What kind of discharge would you expect to find in an otitis externa caused by Candida?

A

Cheesy

78
Q

What kind of discharge would you expect to find in an otitis externa caused by Aspergillus?

A

Fluffy

79
Q

DOC for otitis externa?

A

Ciprodex

80
Q

What causes Mastoiditis?

A

Extension of otitis media into the intomastoid air cells

81
Q

Diagnostic study of choice for suspected mastoiditis

A

CT

82
Q

Triad Asthma (Samter triad)

A

History of:

  • Allergic rhinitis
  • Asthma
  • Aspirin sensitivity
83
Q

Of what should you be suspicious when you find nasal polyps in children?

A

Cystic fibrosis

84
Q

What should you avoid in the treatment of nasal polyps? Why?

A
  • Aspirin

- Because of the likelihood of an aspirin sensitivity

85
Q

What should you think if a patient presents with a chronically draining ear and progressive hearing loss?

A

Cholesteatoma

86
Q

What will a patient experience if a cholesteatoma erodes into the horizontal canal?

A

Vertigo

87
Q

What can happen if a cholesteatoma compresses the facial nerve?

A

Facial droop

88
Q

How do you “check for” a cholesteatoma?

A

CT of the temporal bone

89
Q

What causes a cholesteatoma?

A
  • MC cause is prolonged Eustachian tube dysfunction with resultant chronic negative pressure that draws inward the upper flaccid portion of the tympanic membrane
  • This creates a squamous epithelium-lined sac, which – when its neck becomes obstructed – may fill with desquamated keratin and become chornicaly infected
90
Q

Where do glomus tympanicum tumors arise?

A

In the middle ear

91
Q

What type of tinnitus is associated with a glomus tympanicum?

A

Persistent, pulsatile tinnitus

92
Q

What diagnostic tools are best used to check for a glomus tympanicum tumor?

A

CTA/MRI

93
Q

Which type of epistaxis is more common?

A

Anterior

94
Q

Which type of epistaxis is more worrisome?

A

Posterior

95
Q

MC vascular source of anterior epistaxis

A

Kiesselbach’s plexus in anterior septum

96
Q

What’s usually the cause of nasal vestibulitis?

A

Nasal manipulation or hair trimming

97
Q

What’s the causative organism responsible for nasal vestibulitis?

A

Staph aureus

98
Q

Best imaging study for suspected sinusitis

A

Sinus CT

99
Q

Patient presents with HA, toothache, nasal congestion, and you note severe halitosis when taking the history. Patient says she just had a “cold” 2 weeks ago, but this feels a lot worse. Suspicion?

A

Sinusitis

100
Q

Standard of care for allergic rhinitis?

A

Nasal corticosteroids

101
Q

What organisms are responsible for 75% of sinusitis cases?

A
  • Strep pneumo

- H. influenza

102
Q

DOC for sinusitis

A

Augmentin

103
Q

DOC for strep throat

A

Penicillin

104
Q

Patient presents with a sore throat. You note cervical lymphadenopathy but can’t decide if it’s limited to the anterior region or if it’s more diffuse. You do note, however, a tongue that has a strawberry pattern to it. What do you suspect?

A

Strep throat

105
Q

What might a CBC show in a patient with Strep throat?

A

Elevated WBCs with a left shift

106
Q

What might a CBC show in a patient with Mono?

A

> 30% atypical lymphocytes

107
Q

Lymphadenopathy patterns in strep throat?

A

Anterior cervical

108
Q

Lymphadenopathy patterns in Mono?

A

Diffuse cervical

109
Q

Primary symptom(s) of laryngeal disease

A

Hoarseness and stridor

110
Q

Is stridor and upper or lower airway sound?

A

Upper airway

111
Q

Should you think a laryngeal lesion is above or below the vocal cords with INSPIRATORY stridor?

A

Above

112
Q

Should you think a laryngeal lesion is above or below the vocal cords with EXPIRATORY stridor?

A

Below

113
Q

Patient presents with a complaint of a hoarse voice for 2 1/2 weeks. What should you do?

A

Evaluate by direct laryngoscopy

114
Q

Sialadenitis

A

Bacterial infection of the parotid or submanibular glands

115
Q

Bacterial infection of the parotid or submanibular glands

A

Sialadenitis

116
Q

Most common organism responsible for sialadenitis

A

S. aureus

117
Q

Sialolithiasis

A

Calculus formation in the salivary ducts

118
Q

Calculus formation in the salivary ducts

A

Sialolithiasis

119
Q

Is it more common to have a stone in the Wharton’s or Stenson’s duct?

A

Wharton’s

120
Q

Describe the stones typically found in the Wharton’s ducts

A

Tend to be radiopaque and large

121
Q

Describe the stones that are typically found in the Stenson’s ducts

A

Tend to be small and radiolucent

122
Q

Which glands are drained by the Wharton’s ducts?

A

Submandibular

123
Q

What glands are drained by the Stenson’s ducts?

A

Parotid

124
Q

Where do the majority of salivary gland tumors occur?

A

80% in the parotid gland

125
Q

What percentage of parotid gland tumors are benign?

A

80%

126
Q

What percentage of submanibular tumors are benign?

A

50-60%

127
Q

Is it more likely for a parotid or submanibular gland tumor to be benign?

A

Parotid tumor

128
Q

What’s often the first manifestation of HIV?

A

Candidiasis (thrush) infection

129
Q

What can result from an infection that penetrates the tonsillar capsule and involves the surrounding tissues?

A

A peritonsilar abscess

Clin Med II (9 decks)

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