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Behaviour_Part2 > ENT > Flashcards

ENT Flashcards

1
Q

What is your diagnosis and course of treatment?

A

Dx: Herpes Zoster reactivation

Rx: antivirals (Acyclovir)

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2
Q

What is the most common head and neck malignancy?

A

Squamous Cell Carcinoma (85% of all H&N cancers)

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3
Q
  1. bilat nasal obstruction
  2. purulent rhinorrhea
  3. facial pain

What’s your diagnosis?

A

Acute Sinusitis

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4
Q

What are the criterias for bacterial sinusitis?

A
  1. > 2 PODS
  2. 7 days
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5
Q

After how much time of DYSPHONIA you consider a serious lesion?

A

4 weeks

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6
Q

What is your diagnosis and course of treatment?

A

Dx: Myringitis = TM inflammation

Rx:

  1. Clarithromycin
  2. Puncture of the bullae
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7
Q
  • fever
  • sore throat
  • odynophagia
  • trismus

What’s your diagnosis?

A

Peritonsillar Abscess

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8
Q

What do you suspect if there is a foul-smelling otorrhoea?

A

Cholesteatoma (possibly a tumour)

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9
Q

What is the difference between Cellulitis and Perichondritis?

A

Cellulitis involves the whole pinna and perichondritis spares the lobule

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10
Q
  • unilat nasal obstruction
  • unilat epistaxis
  • eye symptoms

What’s your diagnosis?

A

Sinonasal tumor

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11
Q

What is your diagnosis and course of treatment?

A

Dx: Perichondritis

Rx: Abx Pseudomonal coverage

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12
Q

What pathologies can cause ESOPHAGEAL phase dysphagia?

A
  • Eosinophilic esophagitis
  • Infection (candida)
  • Rings and webs
  • Carcinoma
  • Vascular anomalies
  • Extrinsic masses
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13
Q

What do you suspect in a nasal polyp/blood-stained rhinorrhoea?

A

Tumour

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14
Q
  • sudden vertigo x secs
  • nausea, vomiting
  • no HL
  • no CNS SSx

What’s your diagnosis?

A

Benign Positional Paroxysmal Vertigo

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15
Q

What can be the cause of a secondary otalgia?

A
  1. TMJ
  2. Tube (Eustachian)
  3. Teeth
  4. Tongue
  5. Tonsil
  6. Throat
  7. Thyroid
  8. Trachea, Thorax
  9. Tendons
  10. Tics (glossopharyngeal, trigeminal neuralgia)
  11. Temporal arthritis
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16
Q

What clinical findings suggest a bacterial etiology of a neck mass?

A
  • Warmth or erythema of the overlying skin, swelling or tenderness to palpation of the mass
  • Fever, tachycardia, or other systemic signs of infection
  • Rhinorrhea, odynophagia, otalgia, odontalgia, or other symptoms of a head and neck infection
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17
Q

Is it normal to loose smell with age?

A

YES 75% loss of smell by age 80 is normal

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18
Q

What are the causes of central vertigo?

A
  • Stroke
  • Posterior circulation: vertebral, basilar, anterior inferior cerebellar artery
  • Tumors (cerebellum and 4th ventricle)
  • Multiple Sclerosis (MS): Myelin plaques in the white matter of the brain
  • Migraines
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19
Q

How do we manage a nose bleed?

A
  • Pressure over nasal ala x 10 minutes
  • Evacuate clots
  • Identify source
  • Topical vasoconstrictor and anesthetic
  • Reverse anticoagulation, lower BP
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20
Q

What do you suspect if someone has a hoarse voice for more than 3 weeks?

A

Tumour

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21
Q

What are the differential diagnosis of Anosmia/Hyposmia (loss or decreased smell)?

A
  • Congenital
  • Obstructive nasal disease (23%)
  • Idiopathic (21%)
  • Postinfectious (19%)
  • Head Trauma (15%)
  • Neurologic – Parkinson’s, Alzheimer’s, Multiple Sclerosis
  • Psychogenic (schizophrenia)
  • Toxins/medications (3%)
  • Aging
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22
Q

If you have a non-healing ulcer in the mouth, what can it be?

A

Cancer –> BIOPSY

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23
Q

What is your diagnosis and course of treatment?

A

Dx: TM perforation

Rx:

  • Water precaution
  • Abx drops if signs of infection
  • Eventual surgery if not healed on its own
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24
Q

How do you diagnose Wegener’s Granulomatosis?

A

Labs: cANCA

  • Sensitivity = 65-90%
  • Specificity = 85-98%
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25
Q

What do you suspect if someone has a broken nose but NO nose bleed?

A

SEPTAL HEMATOMA!!

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26
Q

Trials with PPI can be diagnostic and therapeutic for which diagnosis?

A
  1. Globus
  2. Chronic cough
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27
Q

What are the red flags of neck mass that indicate a malignancy?

A
  • Size >1.5 cm
  • Firm texture to palpation
  • Fixed or reduced mobility
  • Ulceration of overlying skin
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28
Q
  • trauma to head
  • clear rhinorrhea
  • anosmia

What’s your diagnosis?

A

CSF leak

29
Q

How do you treat pain when flying?

A
  • Avoid flying when having a cold or sinus infection
  • Oral and topical decongestants
  • Nasal corticosteroids
  • Being awake as soon as descent is initiated
  • Performing step by step equilibrating manoeuvers (Swallowing, Valsalva)
  • Other: EarPlanes ear plugs, Warm compresses etc
30
Q

How can we prevent epistaxis (nose bleed)?

A
  • Humidifier
  • Lubrification nose
    Saline spray
    Gel
    Vaseline
31
Q

What are the complications of actute sinusitis?

A
  • Preseptal cellulitis
  • Abscess
  • Phlegmona
  • Blindness
  • Meningitis
  • Extra or intradural abscess
  • Osteomyelitis
32
Q

What do you suspect in a unilateral deafness?

A

Tumour

33
Q

What are the risk factors for head and neck malignance?

A
  • Smoking
  • ETOH
  • HPV (ON THE RISE)
34
Q

What is the treatement of acture sinusitis?

A
35
Q

What is the treatment of seasonal Allergic Rhinitis?

A

Antihistamines

36
Q

Pure vertical nystagmus is caused by what?

A

CNS problem

37
Q
  • fever, irritable
  • otorrhea
  • otalgia

What’s your diagnosis?

A

Acute otitis media

38
Q

What is the pathological hallmark of sarcoidosis?

A

Non-caseating granulomas

39
Q
  1. Asthma/Allergic Rhinitis
  2. Eosinophilia
  3. Systemic vasculitis of small-medium vessels

What’s your diagnosis?

A

Churg-Strauss Syndrome

40
Q
  • Vertigo attacks of 1-2 hours
  • Pressure and tinnitus (ringing) in left ear, nausea, vomiting during attacks
  • Normal examination

What is your diagnosis?

A

Ménière’s Disease

41
Q

Why is it important to refer for a neck mass that does not go away in 3-4 weeks?

A

TUMOUR

42
Q

What is your diagnosis and course of treatment?

A

Dx: Eustachian tube (ET) dysfunction

Rx:

  • Decongestants, nasal steroids (to help ET)
  • Valsalva manoeuvers
  • Bypass the ET with a tube
43
Q
  • New onset of brief vertigo when loud noise
  • Can hear inner sounds (pulse, blinking, intestinal sounds)
  • Nystagmus

What’s your diagnosis?

A

Superior semicircular canal dehiscence

44
Q

What is the most common bony tumour in the nose and sinuses?

A

Osteoma

45
Q
  • Vertigo for hours and days
  • NO hearing loss

What’s your diagnosis?

A

Vestibular neuronitis –> self-limited

46
Q

What do you have to exclude before diagnosing Ménière’s Disease?

A

An acoustic neuroma (benign tumour of the vestibular nerve) –> ORDER MRI of the Internal auditory canal

47
Q

What are the Red Flags for Urgent Referral for an acute sinusitis?

A
  • Systemic toxicity
  • Altered mental status
  • Severe headache
  • Swelling of the orbit or change in visual acuity
48
Q
  1. Stridor
  2. Respiratory distress
  3. Progressive hoarseness

What’s your diagnosis?

A

RECURRENT RESPIRATORY PAPILLOMATOSIS (RRP)

49
Q
  • —Patient looks distressed, exhausted
  • —Difficulty speaking, or can’t speak
  • —Breathing quickly
  • —Sitting up
  • —Cyanosis

What’s going on?

A

AIRWAY OBSTRUCTION

50
Q

What is the most common pathogen of otitis externa?

A

Pseudomonas

51
Q
  • vocal abuse
  • throat clearing
  • hoarseness

What’s your diagnosis?

A

Vocal cord nodules

52
Q

What pathologies can cause OROPHARYNGEAL phase dysphagia?

A
  • Globus (persistent sensation of having something in the throat)
  • Laryngopharyngeal reflux
  • Stress/anxiety
  • Osteophytes
  • Thyroid mass
  • Muscle tension
  • Cancer
  • Oculopharyngeal muscular dystrophy
  • Cricopharyngeal dysfunction Zenker diverticulitis
53
Q

What is your diagnosis and course of treatment?

A

Dx: skin cancer

Dx: surgical removal

54
Q

Why are posterior nose bleed more severe and important to treat?

A

Because they come from Sphenopalatine artery and this artery supplies 80% of the nose

55
Q

What do you suspect when you see a unilateral polyp in the nose?

A

Schneiderian Papilloma or cancer

56
Q

What do you suspect in a unilateral foul nasal discharge in a child?

A

Foreign body

57
Q
  • bilat progressive HL
  • bilat tinnitus

What’s your diagnosis?

A

Ototoxicity –> IV Gentamycin

58
Q
  • Teenage male
  • Nasal obstruction
  • Nose bleeds

What do you have to rule out?

A

Juvenile Nasopharyngeal Angiofibroma

59
Q

What pathologies can cause ORAL phase dysphagia?

A
  • Dentition
  • Tongue
  • Stroke
  • Parkinsons
  • ALS
  • MS
  • Cancer
  • Tongue tie
  • Macroglossia
60
Q

How do we evaluate dysphagia?

A
  1. Observation
  2. Palpation
  3. Endoscopic Evaluation of Swallowing (FEES): no radiation
  4. Modified Barium Swallow
61
Q
  • biphasic stridor
  • barking cough
  • dysnea

What’s your diagnosis?

A

Croup

62
Q

1) Upper & lower resp tract necotizing granulomas
2) Focal glomerulonephritis
3) Systemic vasculitis

What’s your diagnosis?

A

Wegener’s Granulomatosis

63
Q
  • Vertigo for hours and days
  • Hearing loss

What’s your diagnosis?

A

Labyrinthitis –> URGENT

64
Q

Less than 5 days of:

  • Facial pain/pressure
  • Reduction or loss of smell
  • Nasal congestion/blockage
  • Anterior discharge and/or post-nasal drip (pus from middle meatus)

What’s your diagnosis?

A

Acture sinusitis

65
Q

What is your diagnosis and course of treatment?

A

Dx: cellulitis

Rx: Abx G+ coverage

66
Q

What are the factors inhibiting normal ciliary activity (EXAM QUESTION)?

A
  1. Drying
  2. Drugs (eg. cocaine, adrenaline)
  3. Excessive heat or cold
  4. Hypertonic or hypotonic solutions
  5. Smoking
  6. Infections
  7. Noxious fumes
  8. Genetic (CF, Kartagener’s…)
67
Q

What is the treatment of continuous Allergic Rhinitis?

A

Nasal steroids

68
Q

What neoplastic lesion of the nose presents as progressive enlargement and disfigurement?

A

Fibrous Dysplasia

69
Q
  • snoring
  • apnea (respiratory pauses)
  • daytime fatigue

What’s your diagnosis?

A

Obstructive sleep apnea

Behaviour_Part2 (11 decks)

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