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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
What do you suspect if someone has a broken nose but NO nose bleed?
SEPTAL HEMATOMA!!
26
Trials with PPI can be diagnostic and therapeutic for which diagnosis?
1. Globus 2. Chronic cough
27
What are the red flags of neck mass that indicate a malignancy?
* Size \>1.5 cm * Firm texture to palpation * Fixed or reduced mobility * Ulceration of overlying skin
28
* trauma to head * clear rhinorrhea * anosmia What's your diagnosis?
CSF leak
29
How do you treat pain when flying?
* 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
How can we prevent epistaxis (nose bleed)?
* Humidifier * Lubrification nose Saline spray Gel Vaseline
31
What are the complications of actute sinusitis?
* Preseptal cellulitis * Abscess * Phlegmona * Blindness * Meningitis * Extra or intradural abscess * Osteomyelitis
32
What do you suspect in a unilateral deafness?
Tumour
33
What are the risk factors for head and neck malignance?
* Smoking * ETOH * **HPV (ON THE RISE)**
34
What is the treatement of acture sinusitis?
35
What is the treatment of seasonal Allergic Rhinitis?
Antihistamines
36
Pure vertical nystagmus is caused by what?
CNS problem
37
* fever, irritable * otorrhea * otalgia What's your diagnosis?
Acute otitis media
38
What is the pathological hallmark of sarcoidosis?
Non-caseating granulomas
39
1. Asthma/Allergic Rhinitis 2. Eosinophilia 3. Systemic vasculitis of small-medium vessels What's your diagnosis?
Churg-Strauss Syndrome
40
* Vertigo attacks of 1-2 hours * Pressure and tinnitus (ringing) in left ear, nausea, vomiting during attacks * Normal examination What is your diagnosis?
Ménière’s Disease
41
Why is it important to refer for a neck mass that does not go away in 3-4 weeks?
TUMOUR
42
What is your diagnosis and course of treatment?
Dx: Eustachian tube (ET) dysfunction Rx: * Decongestants, nasal steroids (to help ET) * Valsalva manoeuvers * Bypass the ET with a tube
43
* New onset of brief vertigo when loud noise * Can hear inner sounds (pulse, blinking, intestinal sounds) * Nystagmus What's your diagnosis?
Superior semicircular canal dehiscence
44
What is the most common bony tumour in the nose and sinuses?
Osteoma
45
* Vertigo for hours and days * NO hearing loss What's your diagnosis?
Vestibular neuronitis --\> self-limited
46
What do you have to exclude before diagnosing Ménière’s Disease?
An acoustic neuroma (benign tumour of the vestibular nerve) --\> ORDER MRI of the Internal auditory canal
47
What are the Red Flags for Urgent Referral for an acute sinusitis?
* Systemic toxicity * Altered mental status * Severe headache * Swelling of the orbit or change in visual acuity
48
1. Stridor 2. Respiratory distress 3. Progressive hoarseness What's your diagnosis?
RECURRENT RESPIRATORY PAPILLOMATOSIS (RRP)
49
* —Patient looks distressed, exhausted * —Difficulty speaking, or can’t speak * —Breathing quickly * —Sitting up * —Cyanosis What's going on?
AIRWAY OBSTRUCTION
50
What is the most common pathogen of otitis externa?
Pseudomonas
51
* vocal abuse * throat clearing * hoarseness What's your diagnosis?
Vocal cord nodules
52
What pathologies can cause OROPHARYNGEAL phase dysphagia?
* 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
What is your diagnosis and course of treatment?
Dx: skin cancer Dx: surgical removal
54
Why are posterior nose bleed more severe and important to treat?
Because they come from Sphenopalatine artery and this artery supplies 80% of the nose
55
What do you suspect when you see a unilateral polyp in the nose?
Schneiderian Papilloma or cancer
56
What do you suspect in a unilateral foul nasal discharge in a child?
Foreign body
57
* bilat progressive HL * bilat tinnitus What's your diagnosis?
Ototoxicity --\> IV Gentamycin
58
* Teenage male * Nasal obstruction * Nose bleeds What do you have to rule out?
Juvenile Nasopharyngeal Angiofibroma
59
What pathologies can cause ORAL phase dysphagia?
* Dentition * Tongue * Stroke * Parkinsons * ALS * MS * Cancer * Tongue tie * Macroglossia
60
How do we evaluate dysphagia?
1. Observation 2. Palpation 3. Endoscopic Evaluation of Swallowing (FEES): no radiation 4. Modified Barium Swallow
61
* biphasic stridor * barking cough * dysnea What's your diagnosis?
Croup
62
1) Upper & lower resp tract necotizing granulomas 2) Focal glomerulonephritis 3) Systemic vasculitis What's your diagnosis?
Wegener’s Granulomatosis
63
* Vertigo for hours and days * Hearing loss What's your diagnosis?
Labyrinthitis --\> URGENT
64
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?
Acture sinusitis
65
What is your diagnosis and course of treatment?
Dx: cellulitis Rx: Abx G+ coverage
66
What are the factors inhibiting normal ciliary activity (**EXAM QUESTION**)?
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
What is the treatment of continuous Allergic Rhinitis?
Nasal steroids
68
What neoplastic lesion of the nose presents as progressive enlargement and disfigurement?
Fibrous Dysplasia
69
* snoring * apnea (respiratory pauses) * daytime fatigue What's your diagnosis?
Obstructive sleep apnea

Behaviour_Part2 (11 decks)

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