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elmaya > ENT > Flashcards

ENT Flashcards

1
Q

Name the anatomical landmarks for the three zones of the neck.

A

Zone 1: Clavicle to cricoid (can image first)
Zone 2: Cricoid to angle of the mandible (go to OR)
Zone 3: Angle of the mandible to base of skull (can image first)

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2
Q

What ingestions can cause peripheral vertigo (name 4)?

A

aminoglycosides, furosemide, salicylates, ethanol

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3
Q

Symptoms of a basilar migraine (name 4)

A

occipital headache + sx of brainstem dysfunction – vertigo, ataxia, tinnitus, dysarthria

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4
Q

DDX Pseudovertigo (list 8)

A
  • Psych: Depression, Anxiety
  • Hyperventilation
  • Orthostatic hypotension
  • Heat exhaustion or stroke
  • Arrhythmia, Cardiac disease
  • Anemia
  • Hypoglycemia
  • Pregnancy
  • Ataxia
  • Visual disturbance
  • Psychogenic disturbance
  • Dehydration
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5
Q

Step-wise management of epistaxis

A
  1. Apply steady pressure to anterior nasal septum 5-10 minutes, leaning forward; cotton dental roll under lip to compress labial artery
  2. Cotton pledgets with epinephrine for vasoconstriction
  3. Anterior nasal packing (absorbable gel foam or Vaseline impregnated gauze) or expandable nasal tampons (ie. Merocel) for severe bleeding, or rapid Rhino (inflatable nasal tampon) –> give amox-clav if packing
  4. Cautery of anterior bleeding site with silver nitrate
  5. Posterior packing (ENT)
  6. Surgical ligation for more severe bleeds or angiography (embolization)
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6
Q

Complications of nasal packing

A

Bacterial rhinosinusitis, toxic shock, necrosis, septal ulcer/ perforation, hypoxemia/ resp distress from sedation and nasal airway obstruction

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7
Q

List the steps in managing aspirated foreign body in upper airway

A

Back blows and chest compressions in infants
Heimlich in older kids if conscious
CPR if unresponsive with direct visualization and manual extraction

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8
Q

Syndromes associated with sensorineural hearing loss (4)

A 
Waardenburg syndrome (white forelock)
Jervell and Lange Nielson Syndrome (with prolongation of QTc)
Usher syndrome (retinitis pigmentosa)
Alport syndrome (males)
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9
Q

Life threatening causes of acute hearing loss (list 4)

A

Acute head injury, brain tumor, leukemic infiltrate, vascular insufficiency

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10
Q

Findings of a neck lymph node that are concerning for malignancy

A

supraclavicular node, >2cm, enlargement of node for more than 2 weeks, no regression of node after 4-6 weeks, lack of inflammation, firm or rubbery, ulceration, failure to respond to antibiotics, systemic symptoms

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11
Q

What is Lemierre syndrome and what bacteria commonly causes it?

A

Thrombophlebitis of internal jugular vein with septic pulmonary emboli
Gram neg bacilli Fusobacterium necrophorum

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12
Q

Common causes of cervical lymphadenitis, and what is the antibiotic of choice?

A
  • staphylococcal aureus, GAS, H. influenza, anaerobes

- amox-clav, keflex (clindamycin for MRSA)

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13
Q

Common causes of parotitis?

A
  • Viral causes are most common: mumps virus, parainfluenza types 1 and 3, influenza A, Coxsackie virus A, EBV, CMV
  • Bacterial causes less common, usually severe and unilateral (except in neonates - can be bilateral)
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14
Q

Complications of mumps (6)

A
  • parotitis
  • orchitis
  • encephalitis, meningitis
  • pancreatitis
  • labyrinthitis
  • myocarditis
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15
Q

How to differentiate rotary subluxation vs. muscular torticollis?

A
  • Rotary atloantoaxial subluxation (C1 and C2 “locked” in rotated position) = SCM spasm and neck tenderness on same side as the chin. Treat with NSAIDS and soft collar.
  • Muscular torticollis = tender SCM opposite direction of the chin
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16
Q

What is Grisel’s syndrome?

A

Rotary atlantoaxial subluxation from local inflammatory or ENT procedure (RA, SLE, tonsillitis, pharyngitis, OM, RPA, T+A) ; due to ligamentous laxity

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17
Q

What bacteria cause otitis externa?

A

Staphylococcal aureus and pseudomonas

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18
Q

Treatment of otitis externa?

A
  • Debride ear canal
  • Ciprodex otic drops for 10 days
  • If narrow canal can place wick in ear soaked in drops to help reach inflammation – expands with the drops, change every 24 hours
  • Analgesia
19
Q

Auricular perichondritis - causes, bacteria involved, treatment?

A
  • Infection of cartilage of ear that occur in setting of trauma or surgery or piercing
  • Caused by pseudomonas
  • Treatment: pseudomonas coverage such as ceftazidime or ciprofloxacin usually IV
20
Q

Otitis media - causes?

A
  • viral most common

- streptococcus pneumoniae, haemophilus influenza, Moraxella catarrhalis, GAS

21
Q

Otitis media complications (list 6)?

A
  • perforated AOM
  • mastoiditis
  • suppurative labyrinthitis
  • facial nerve palsy
  • CN VI palsy (Gradenigo syndrome)
  • venous sinus thrombosis
  • meningitis
  • intracranial abscess
22
Q

Otitis media - treatment

A

< 6 months: treat high dose amox
> 6 months - mild: watchful waiting
> 6 months - severe: amoxicillin 80-90 mg/kg/day divided BID (5 days if > 2 yo, 10 days if < 2 yo)
If perforated, can add ciprodex drops

23
Q

Mastoiditis - clinical features (4)

A
  • fever, malaise, lethargy
  • swelling / erythema of mastoid process
  • displaced the auricle forward and downward
  • TM red and bulging
24
Q

Mastoiditis - complications (6)

A
  • subperiosteal abscess
  • CN palsy V and VI most common (then VI and VIII)
  • meningitis
  • intracranial abscess, extradural abscess
  • venous sinus thrombosis
  • labyrinthitis
  • Bezold abscess
25
Q

Life threatening causes of a sore throat

A

RPA, epiglottitis, severe tonsillitis from EBV, diphtheria, PTA, Lemierre syndrome

26
Q

Xray findings of epiglottitis

A
  • thumb print sign
  • loss of valecula
  • thickening aryethenoids
  • dilated hypopharynx
  • soft tissue edema
27
Q

4 ways to remove foreign body in ear canal

A
  • Curette (visualize +/- speculum, pass curette past the FB)
  • Forceps (with speculum + visualization)
  • Irrigation (C/I if food material/ bean, or can’t see the TM)
  • Day ear hook
  • Katz extractor (inflatable balloon at the end)
28
Q

4 ways to remove a nasal foreign body.

2 nasal foreign bodies that need to be removed urgently.

A
  • mother’s kiss
  • suction
  • dermabond on a stick
  • Katz extractor
  • forceps

Urgent removal: 2 magnets, button battery, organic matter

29
Q

Halitosis – 3 oral causes, 3 non-oral causes

A

Oral causes: decrease solid and liquid intake (most common), dental caries, dental abscess, strep pharyngitis, gingivitis

Non-oral causes: nasal foreign bodies, sinusitis, lung abscesses, empyema, bronchiectasis, GERD, Zenker diverticulum

30
Q

Auricular Hematoma – complications and describe procedure to drain it

A

Complications: necrosis - cauliflower ear, infection - perichondritis, reaccumulation of hematoma

  1. Provide local analgesia with EMLA, topical lido
  2. Palpate the most fluctuant portion of the hematoma
  3. Clean with proviodine
  4. Drain hematoma with 18-20G needle entered at most fluctuant portion, milk the blood out of the ear with other hand - or use a scalpel to create a small incision
  5. Apply pressure dressing
  6. PO antibiotics for 7-10 days (amox clav or ciprofloxacin in older children)
  7. Follow-up in 1-2 days for new dressing
31
Q

Traumatic TM perforation - when to refer to ENT (4 reasons)

A
  • Sx of vertigo
  • tinnitus
  • hearing loss
  • facial nerve palsy
  • not healing in 3 weeks (can lead to cholesteatoma)
  • > 20% of diameter of TM
32
Q

2 complications of nasal septal hematoma

A
  • necrosis - perforation of septum - saddle nose

- infection

33
Q

Which area of palate is most dangerous for a penetrating wound?

A
  • Lateral palate (soft palate/ tonsillar fossa) = high risk for vascular injury

Central / hard palate = low risk

Posterior pharyngeal wall = vascular injuries - hematoma/ infection

34
Q

Hard signs to go to OR for penetrating neck trauma (list 7)

A

HARD Bruit:

  • Hemodynamically unstable, hemoptysis, hematemesis
  • Arterial bleed
  • Rapidly expanding hematoma
  • Deficit - neuro or vascular
  • Bruit or thrill
35
Q

3 clinical criteria to diagnose sinusitis

A
  • Persistent illness > 10 days (nasal discharge, cough)
  • Worsening course
  • Severe (fever, purulent nasal discharge > 3 days)
36
Q

Retropharyngeal abscess - features on xray (list 4)

A
  • increase width of pre-vertebral tissue (> 1/2 adjacent vertebral body)
  • air fluid level
  • subcutaneous emphysema
  • loss of normal cervical lordosis
37
Q

Common timing for post-tonsillectomy bleed?

A

When eschar falls off between 7-10 days

38
Q

Retropharyngeal abscess - 3 common organisms?

A

Group A strep, Staph aureus, anaerobes

Treat with IV clindamycin (add cloxacillin or vancomycin if suspect MRSA)

39
Q

List 8 areas of the face you would palpate looking for a fracture

A
  • Supraorbital ridges
  • Infraorbital ridges
  • Zygomatic arches
  • Nasal bone
  • Maxilla
  • Intranasal exam - including nasal septum
  • Occlusion of teeth
  • Mandible
40
Q

5 locations where the mandible can fracture

A 
A.	Symphysis 
B.	Body
C.	Angle (most common in teens)
D.	Ramus
E.	Condyle (most common - associated with chin lacerations)
41
Q

Complications of chronic TM perforation (4)

A

hearing loss, cholesteatoma, facial nerve injury and perilymphatic fistula

42
Q

Indications to repair a tongue laceration (3)

A

Large lacerations involving free edge (risk of notch → dysfunction), forked tongue
Large flaps
Inability to stop bleeding

43
Q

Deep laceration of cheek - 3 important structures to consider

A
  1. Facial Nerve – buccal branch ( midcheek to tragus)
  2. Parotid duct
  3. Parotid gland

elmaya (5 decks)

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