ENT Flashcards
1
Q
Is the onset of peripheral or central vertigo more sudden?
A
Peripheral
2
Q
Is peripheral or central vertigo associated with auditory symptoms?
A
Peripheral
3
Q
What is the most important aspect of vertigo evaluation?
A
History
4
Q
Is peripheral or central vertigo usually lessened with closed eyes?
A
Central
5
Q
Is peripheral or central vertigo usually lessened with open eyes that are fixated on a nonmoving object?
A
Peripheral
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
7
Q
What clinical tool can aid in the evaluation of spontaneous nystagmus by eliminating the factor of visual fixation?
A
Frenzel glasses
8
Q
Describe the nystagmus that typically accompanies peripheral vertigo
A
-Usually horizontal with a rotary component
9
Q
Describe the nystagmus that typically accompanies central vertigo
A
Any of the following:
- Vertical
- Bi-directional
- Unilateral
10
Q
MC cause of central vertigo
A
Drugs
11
Q
Can the nystagmus that accompanies central or peripheral vertigo be suppressed by visual fixation on a nonmoving object?
A
Peripheral
12
Q
What’s the most direct way of making the distinction between central and peripheral vertigo?
A
Ask about and evaluate brainstem symptoms
13
Q
Vertigo caused by distention of the endolymphatic compartment of the inner ear
A
Meniere’s Disease
14
Q
With what pathology are episodes of vertigo lasting minutes to hour associated?
A
Meniere’s Disease
15
Q
With what pathology is the symptomatic triad of SNHL, tinnitus, and vertigo associated?
A
Meniere’s Disease
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
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
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
19
Q
Patient presents with vertigo, tinnitus, and hearing loss. PMH significant for recent URI. Suspicion?
A
Acute labyrinthitis
20
Q
Describe the duration of vertigo associated with acute labyrinthitis
A
Acute onset of continuous, usually severe, vertigo lasting several days to weeks
21
Q
Vertigo associated with changes in head position
A
Benign positional vertigo
22
Q
Describe the duration of vertigo associated with benign positional vertigo
A
-Recurrent spells of vertigo last seconds to minutes each time
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
24
Q
Describe the symptoms associated with Meniere’s disease
A
- Hearing loss
- Tinnitus
- Vertigo lasting minutes to hours
25
Describe the symptoms associated with Acute labyrinthitis
- Acute onset of continuous vertigo lasting days to weeks
- Hearing loss
- Tinnitus
26
Describe the symptoms associated with Benign positional vertigo
-Vertigo lasting seconds to minutes
27
Describe the symptoms associated with Vestibular neuronitis
Isolated vertigo lasting several days to a week with NO hearing loss
28
Treatment for vestibular neuronitis
Corticosteroids
29
Describe the symptoms associated with Vascular compression of the vestibular nerve
- Disabling positional vertigo
| - Severe nausea
30
What drugs are most injurious to the vestibular portion of CN VIII?
Streptomycin and Gentamycin
31
What's the most worrisome peripheral cause of vertigo?
Vestibular schwannoma (AKA "Acoustic neuroma")
32
Describe the symptoms of a vestibular schwannoma
- Slowly progressive
- ASYMMETRIC hearing loss
- Tinnitus
- Deteriorization of speech discrimination
- Possible facial numbness/weakness
- Vague vertigo
33
What pathology is associated with the following symptoms?
- ASYMMETRIC hearing loss
- Tinnitus
- Deteriorization of speech discrimination
- Possible facial numbness/weakness
- Vague vertigo
Vestibular schwannoma
34
What is one of the earliest signs of vestibular schwannoma extension outside of the internal auditory meatus?
Decreased corneal reflex
35
What cause of vertigo is associated with constant, disabling positional vertigo?
Vascular compromise of the vestibular nerve
36
What might be the cause of vertigo lasting days to a week with no associated hearing loss?
Vestibular neuronitis
37
What might be the cause of vertigo lasting seconds to minutes associated with changes in head position?
Benign positional vertigo
38
Patient presents with a 1 week history of vertigo. PMH significant for a MVA 8 days ago. Suspicion?
Temporary head trauma vertigo
39
MCC of vertigo following a head injury
Labyrinthine concussion
40
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?
Basilar skull fracture
41
Leakage of perilymphatic fluid from the inner ear into the tympanic cavity via the round or oval window (pathology)
Perilymphatic fistula
42
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?
Perilymphatic fistula from a round/oval window rupture
43
Describe the symptoms that are associated with a perilymphatic fistula
- Vertigo that's worse with straining
| - SNHL
44
Vertigo associated with dysfunction of the proprioceptors in the cervical neck that's triggered by neck movements (Pathology)
Cervical vertigo
45
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?
Cervical vertigo
46
Causes of cervical vertigo
- Neck injury (particularly hyperextension injuries)
| - Degenerative spine disease
47
Describe the symptoms associated with cervical vertigo
-Vertigo that may be triggered by assuming a particular head position
48
Describe the (relevant) symptoms of multiple sclerosis (those relating to ENT)
- Episodic vertigo and chronic imbalance
- Hearing loss that's commonly unilateral and of rapid onset
- Slight facial numbness, Huskiness of the voice
- Positional nystagmus
49
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
Multiple sclerosis
50
Describe the symptoms that are often associated with vertebrobasilar insufficiency
- Vertigo
| - Other symptoms like diplopia, sensory loss, dysarthria, dysphagia, hemiparesis, and other brainstem deficits
51
What's a good way to determine the difference between benign positional vertigo and vertebrobasilar insufficiency?
-Vertebrobasilar insufficiency will cause vertigo associated with brainstem symptoms, while benign positional vertigo is not associated with other symptoms
52
What types of drugs can cause central vertigo?
- Sedatives
- Antibiotics
- Anticonvulsants
- Analgesics
- ETOH
53
What type of x-ray shows the nasal bones the best?
Lateral head x-ray
54
Hearing loss that results from dysfunction of the external or middle ear
Conductive hearing loss
55
Hearing loss that results from deterioration of the cochlea, usually due to loss of hair cells from the organ of Corti
Sensorineural hearing loss
56
Is most hearing loss due to disease of the cochlea symmetric or asymmetric?
Symmetric
57
High frequency hearing loss
Presbyacucis
58
Presbyacusis
High frequency hearing loss
59
What's the 2nd most common cause of SNHL?
Loud noise trauma
60
Sounds over ______dB for prolonged exposure will cause permanent hearing damage
85
61
What drugs cause IRREVERSIBLE ototoxicity?
- Aminoglycosides
- Loop diuretics
- Antineoplastic agents
62
Treatment of sudden sensory hearing loss
- Prednisone
| - Serial audiograms
63
Is autoimmune hearing loss typically symmetric or asymmetric?
Symmetric
64
Tx for autoimmune hearing loss
Corticosteroids
65
CHL weber test
Sound lateralizes to the affected/worse ear
66
SNHL Weber test
Sound lateralizes to the unaffected/better ear
67
CHL Rinne test
Bone conduction > air conduction
68
SNHL Rinne test
Air conduction > bone conduction, but it's unequal on both sides
69
Why is SOM more common in children?
Their eustachian tubes are narrower and more horizontal than adults
70
What should you be thinking if you have chronic or unilateral serous otitis media in an adult with a history of smoking?
Tumor
71
What are you required to do if you AOM in any neonate?
A workup for sepsis
72
Most common cause of AOM
Strep pneumo
73
Drug of choice for AOM
Amoxicillin/Augmentin
74
Most common cause of otitis externa
Pseudomonas
75
What kind of discharge would you expect to find in an otitis externa caused by Pseudomonas?
Green
76
What kind of discharge would you expect to find in an otitis externa caused by Staph aureus?
Yellow
77
What kind of discharge would you expect to find in an otitis externa caused by Candida?
Cheesy
78
What kind of discharge would you expect to find in an otitis externa caused by Aspergillus?
Fluffy
79
DOC for otitis externa?
Ciprodex
80
What causes Mastoiditis?
Extension of otitis media into the intomastoid air cells
81
Diagnostic study of choice for suspected mastoiditis
CT
82
Triad Asthma (Samter triad)
History of:
- Allergic rhinitis
- Asthma
- Aspirin sensitivity
83
Of what should you be suspicious when you find nasal polyps in children?
Cystic fibrosis
84
What should you avoid in the treatment of nasal polyps? Why?
- Aspirin
| - Because of the likelihood of an aspirin sensitivity
85
What should you think if a patient presents with a chronically draining ear and progressive hearing loss?
Cholesteatoma
86
What will a patient experience if a cholesteatoma erodes into the horizontal canal?
Vertigo
87
What can happen if a cholesteatoma compresses the facial nerve?
Facial droop
88
How do you "check for" a cholesteatoma?
CT of the temporal bone
89
What causes a cholesteatoma?
* 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
Where do glomus tympanicum tumors arise?
In the middle ear
91
What type of tinnitus is associated with a glomus tympanicum?
Persistent, pulsatile tinnitus
92
What diagnostic tools are best used to check for a glomus tympanicum tumor?
CTA/MRI
93
Which type of epistaxis is more common?
Anterior
94
Which type of epistaxis is more worrisome?
Posterior
95
MC vascular source of anterior epistaxis
Kiesselbach's plexus in anterior septum
96
What's usually the cause of nasal vestibulitis?
Nasal manipulation or hair trimming
97
What's the causative organism responsible for nasal vestibulitis?
Staph aureus
98
Best imaging study for suspected sinusitis
Sinus CT
99
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?
Sinusitis
100
Standard of care for allergic rhinitis?
Nasal corticosteroids
101
What organisms are responsible for 75% of sinusitis cases?
- Strep pneumo
| - H. influenza
102
DOC for sinusitis
Augmentin
103
DOC for strep throat
Penicillin
104
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?
Strep throat
105
What might a CBC show in a patient with Strep throat?
Elevated WBCs with a left shift
106
What might a CBC show in a patient with Mono?
> 30% atypical lymphocytes
107
Lymphadenopathy patterns in strep throat?
Anterior cervical
108
Lymphadenopathy patterns in Mono?
Diffuse cervical
109
Primary symptom(s) of laryngeal disease
Hoarseness and stridor
110
Is stridor and upper or lower airway sound?
Upper airway
111
Should you think a laryngeal lesion is above or below the vocal cords with INSPIRATORY stridor?
Above
112
Should you think a laryngeal lesion is above or below the vocal cords with EXPIRATORY stridor?
Below
113
Patient presents with a complaint of a hoarse voice for 2 1/2 weeks. What should you do?
Evaluate by direct laryngoscopy
114
Sialadenitis
Bacterial infection of the parotid or submanibular glands
115
Bacterial infection of the parotid or submanibular glands
Sialadenitis
116
Most common organism responsible for sialadenitis
S. aureus
117
Sialolithiasis
Calculus formation in the salivary ducts
118
Calculus formation in the salivary ducts
Sialolithiasis
119
Is it more common to have a stone in the Wharton's or Stenson's duct?
Wharton's
120
Describe the stones typically found in the Wharton's ducts
Tend to be radiopaque and large
121
Describe the stones that are typically found in the Stenson's ducts
Tend to be small and radiolucent
122
Which glands are drained by the Wharton's ducts?
Submandibular
123
What glands are drained by the Stenson's ducts?
Parotid
124
Where do the majority of salivary gland tumors occur?
80% in the parotid gland
125
What percentage of parotid gland tumors are benign?
80%
126
What percentage of submanibular tumors are benign?
50-60%
127
Is it more likely for a parotid or submanibular gland tumor to be benign?
Parotid tumor
128
What's often the first manifestation of HIV?
Candidiasis (thrush) infection
129
What can result from an infection that penetrates the tonsillar capsule and involves the surrounding tissues?
A peritonsilar abscess
