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Clin Med I Exam 3 Heme/ENT > ENT > Flashcards

ENT Flashcards

1
Q

he health status of the oral cavity is linked to

A

cardiovascular disease

diabete

other systemic illnesses.

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2
Q

Assume any head and neck infection or swelling to be _______ in origin until proven otherwise.

A

odontogenic

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3
Q

Caries is what type of infection

A

bacterial

  • causes demineralization and destruction of the hard tissues of the teeth (enamel, dentin and cementum).
  • Caries are the result of the production of acid by bacterial fermentation of food debris accumulated on the tooth surface.
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4
Q

Caries are formed If ______ exceeds saliva and other_______ factors

A

demineralization

remineralizing

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5
Q

caries are likely a result of the acidic secretions of what bacteria

A

strep mutans

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6
Q

name some other bacterial agents implicated w/ caries

A
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7
Q

populations at risk for periodonatal dz

A

diabetics

elderly

pregnant women - preg gingivitis due to hormonal changes promoting increase in alterations in types and amounts of pathogens

•Pyogenic Granuloma- Occur in 1% of women, Exaggerated response to irritation

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8
Q

Jaw pain can be [an] ______ equivalent

A

anginal

postmenopausal women / long-term diabetic patients

and especially lower-left portion of the jaw

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9
Q

Si/ Sx of dental caries

A
  • Sensitivity to hot or cold stimuli
  • Pain on biting (trigeminal nerve)
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10
Q

children < 4 y.o. with stiff neck, sore throat and dysphagia should be worked up for ______ ______

A

retropharyngeal abscess secondary to molar infection

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11
Q

fils mordered for suspected infection

A

•Panoramic film of the teeth and jaw for evaluation of the extent of the infection

CT w/o contrast determine the extent and density of the swelling, locating the abscess within the soft tissue and bone (aids in determining tx)

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12
Q

first line tx for dental infection

A

Pen VK

Amox

If PCN allergic:

clinda or erythro

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13
Q

second line dental inf tx

A

•If long-standing infection or previously treated infection that does not respond to first line treatment:

oral clinda

IF SEVERE consider clinda + double coverage with metronidazole (B. fragilis and C. diff)

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14
Q

admission criteria for pts w/ dental infections

A
  • swelling involving deep spaces (pre fascial planes) of the neck
  • unstable vital signs, fever, chills, confusion or delirium
  • evidence of invasive infection
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15
Q

complications of dental infections

A
  • Ludwig’s angina (sublingual cellulitis, +/- tracking abscess inferiorly; potential for airway issue)
  • Vincent’s angina, aka ANUG (acute necrotizing ulcerative gingivitis), aka ‘trench mouth’
  • Smells HORRIBLE, “worst breath you have ever smelt
  • Retropharyngeal infection (possibility of retropharyngeal abscess) and mediastinal infection
  • Child w/ fever, dysphagia, neck stiffness think retropharyngeal abscess
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16
Q

acute vs chronic rhinosinusitis timeframe

A
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17
Q

sublingual cellulitis is

A

Ludwig Angina

•Note the diffuse submandibular swelling and fullness.

airway compromise is a major concern

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18
Q

most common pathpgens responsible for viral sinustitis

A
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19
Q

most common bacterial pathogens responsible for rhinosinusitis

A
  • S. pneumoniae
  • H. flu
  • M. catarrhalis
  • S. aureus
  • S. pyogenes
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20
Q

dx criterial for acute viral vs bacterial sinusitis

A

<•10 days nonworsening sx - viral

>10 days or biphasicor worsening ® bacterial

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21
Q

tx for bacterial sinusitis

A
  • Amoxicillin
  • Augmentin
  • Doxycycline
  • Levofloxacin
  • Moxifloxacin

•

•Macrolides no longer recommended due to resistant so S. pnuemoniae

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22
Q

•Nasal mucopurulent drainage (“post-nasal drip”) is seen with?

A

chronic sinusitis

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23
Q

cough in children is a sx of

A

chronic sinusitis

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24
Q

3 types of chronic sinusitis

A
  • Chronic w/ nasal polyposis (20%)
  • Allergic fungal rhinosinusitis (8-10%)
  • Chronic w/o nasal polyps (60%)
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25
Q

dx criteria symptom wise for chronic sinusitis

imaging dx?

A

– 2 of 4

  1. Anterior/posterior mucopurulent drainage
  2. nasal obstruction/blockage/congestion
  3. Facial pain, pressure, fullness
  4. Reduction or loss of sense of smell

Objective evidence w/ one or more using nasal endoscopy or CT

  1. Purulent (not clear) mucus or edema in middle meatus or ethmoid
  2. Polyps in nasal cavity or middle meatus
  3. Imaging showing mucosal thickening, partial or complete opacification of paranasal sinuses
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26
Q

tx chronic sinusitis w/ Nasal polyps present

A
  • Oral glucocorticoids
  • Dupilumab (Dupixent)
  • Abx if infection
  • Allergy/immune eval
  • Endoscopic surgery
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27
Q

tx chronic sinusitis w/o nasal polyps

A
  • Intranasal saline irrigation
  • Intranasal glucocorticoids
  • Oral abx/GCs – if no improvement in 2-4 wks
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28
Q

preferred imaging for chronic sinusitis

A

•CT – preferred imaging modality - sinus mucosal thickening, polyps, sinus opacification

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29
Q

•Palatal click – when scratching palate w/ tongue is assoc w/

A

allergic rhinitis

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30
Q

si/sx of allergic rhinitis

A
  • Infraorbital edema & darkening (“allergic shiners”)
  • Accentuated lines below eyes (Dennie-Morgan lines)
  • Transverse nasal crease (“nasal salute”)
  • Hyperplastic lymphoid tissue lining post. Pharynx (“cobblestoning”)
  • Retracted TM
  • Nasal mucosa pallor
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31
Q
  • Prick skin test
  • IgE immunoassays (RAST)

used to dx?

A

allergies

patch better

RAST better w/ severe allergies

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32
Q

common source of bleeding in anterior vs posterior nose bleeed

A
  • Anterior ® Keisselbachs plexus (most common) involves branches of anterior ethmoid artery, sphenoplantine and facial a.
  • Posterior ® sphenopalatine a. or branches of carotid a. (significant)
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33
Q

tx minor epistaxis

A
  • Tamponade
  • Silver nitrate
  • Electrocautery w/ anesthetization
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34
Q

tx of major epistaxis

A
  • Nasal packing – contralateral nare if bleeding persists for tamponade
  • ENT consultation
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35
Q

what risk is assoc w/ packing a nose bleed

A

TSS - prophylaxis is augemntin or cephalexin

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36
Q

positive pressure techniques such as a mothers kiss can help tx

A

FB impaction

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37
Q

common FB impactions

A
  • Button batteries – at neg poly electrolysis generates hydroxide ions that cause alkaline tissue necrosis or septal perf
  • Paired disc magnets – perf from chronic compression
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38
Q

complciations fo FB

A
  • Septal perforation w/ saddle nose deformity
  • Nasal meatal stenosis
  • Inferior turbinate necrosis
  • Cartilage collapse
  • Epistaxis
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39
Q

fucntions of ET (3)

A
  • Equalizing pressure across TM
  • Protecting middle ear from infection and reflux of nasopharyngeal contents
  • Clearance of middle ear secretions
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40
Q

ET tube dysfucntion can be caused by (3)

A
  1. Pressure dysregulation
  2. Impaired protective function – reflux into ET
  3. Diminished clearance
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41
Q

ET dysfucntion assoc w/

A
  • Any cause of inflammation (ex. allergies, exposure to smoking)
  • Hypertrophied adenoids
  • Laryngopharyngeal reflux
42
Q

pt presents w/

  • Ear pain
  • Sensation of ear fullness or pressure
  • Hearing loss
  • “Popping” or “snapping” noise

autophony

dx?

A

ET tube dysfunction

43
Q

Tx Et tube (meds and surgical

A

Medical management

  • Decongestants –phenylephrine pseudoephrine
  • Intranasal glucocorticoids
  • Nasal saline drops

Surgical management

  • Tympanostomy Tubes – first line surgical tx
  • Eustachian tuboplasty
  • Balloon dilation of the eustachian tube (BDET)
44
Q

Cholesteatoma is a complicaiton of

A

ET

45
Q

peripheral vs central vertigo

A

peripheral •Disorders affecting labyrinth or vestibular nerves (ex. vestibular neuritis)

Central

•Disruption of central vestibular pathway

46
Q

when to use HINTS test

A

•acute onset persistent vertigo to diff b/w vestibular neuritis (benign) from central cause (life threatening)

47
Q

si/sx vertigo

A
48
Q

positive Head impulse test indicated

A

perip vertigo (diff b/w central and peripheral)

49
Q

Vestibular Nystagmus is

A

horizontal nystagmus w/ fast going away from affected side

50
Q

Torsional (rotary) nystagmus –

A

can be any direction and may reverse direction,

central sign

Not suppressed by visual fixation –

life thretaning

51
Q

tx vertigo

A
  • Symptom management
  • Vestibular rehab – balance activities
  • Antihistamines
  • Benzos
  • Anti-emetics
52
Q

Acute onset sustained vertigo – assess ____ _____

Episodic vertigo asses for ___ using _____

A

vestibular neritis

BBPV – dix-haplike

53
Q

Menieres dz is caused by

and lasts

A

Excess endolymph in the inner ear ® distortion & distension of the membranous labyrinth (excess fluid)

minutes to hours

54
Q

Meniere’s disease is hearing loss that first affects __-pitched sounds and is assoc w/ intense ipselateral aural ____ and head ______

A

low

aural fullness and head pressure

55
Q

tx for menieres dz

A
  • Dietary modification
  • Vestibular rehab
  • Vasodilators or diuretic
  • HCTZ / triamterene PO daily
  • Benzos – acute vertigo attack
  • Systemic glucocorticoids –dexmethaosne
  • Intratympanic steroid injection or gentamycin
  • Surgery (ex. labyrinthectomy, vestibular neurectomy)
56
Q

diagnostic test of choice for menieres

A

Audiometry - •documented low to mid frequency sensorineural hearing loss in affected ear)

57
Q

Labyrinthitis is defined as an acute onset of severe vertigo w/ N/V and gait instability with ________

Vestibular neuritis an acute onset of severe vertigo w/ N/V and gait instability with ______.

A

unilateral hearing loss

preserved autiory function

58
Q

Vestibular neuritis acute onset vertigo without hearing loss that persistens when head is ____, unlike ____

A

Persists when head is still unlike BPPV

59
Q

labrynth and vestibular nueritiis both present w/

A

severe vertigo

N/V

gait disturbances

60
Q

when evaluating labrynthitis and vest. nueritis the head impulse test will be (+/-) meaning …

A

+ head impulse test – pt unable to maintain visual fixation w/ rapid head turns

61
Q

when evaluating labrynthitis and vest. nueritis Nystagmus is

A

suppressed w/ visual fixation, beats away from affected side

62
Q

Loose otoconia in the vestibule or the utricle

that presents w/ recurrent episodes of vertigo lasting one minute or less that are provoked by specific head movements

A

Benign paroxysmal positional vertigo (BPPV)

63
Q

when evaluating BPPV the Dix Hallpike maneuver will

A
64
Q

what would we tx w/ the Particle repositioning maneuver (ex. Epley maneuver) ?

goal of tx?

A

BPPV - NO MEDS

– goal is to have debris migrate toward common crus of anterior and posterior canals and exit utricular cavity

65
Q

how to tx labryn and vestib neuritis

A

Prednisone taper dose pack

Antihistamines

Anticholinergics

Benzos

Vestibular rehab

66
Q

recurrent vertigo lasting under a minute

A
67
Q

acute onset of vertigo that persist for a few days

A

vestoibular neuritis

68
Q

Peripheral vertigo lasting minutes to hours

A

Meniere’s disease

69
Q

dz characterized by disruption of normal neural firing patterns along the entire auditory pathway

A

tinnitus

70
Q

si/sx of tinnitus

A
  • Ringing or buzzing in one or both ears
  • +/- hearing loss
  • High-pitched tinnitus ® sensorineural
  • Low-pitched tinnitus ® Meniere’s
  • Rushing, flowing or humming à vascular in origin
  • Clicking tinnitus ® MSK
71
Q

high-pitch tone loss =

low pitch tone loss =

Rushing, flowing or humming =

Clicking tinnitus =

A

sensorinueral

menieres

vascualr origin

physiological / MSK

72
Q

•MRA/CT in tinnitus if we suspect

A

vasc origin

73
Q
  • Cochlear implants
  • Hearing aids
  • Discontinue ototoxic meds
  • Angiographic embolization or surgical resection

tx for?

A

tinnitus

74
Q

sensorinueral hearing impairment

A
75
Q

conductive hearing loss:

A
76
Q

mixed hearing loss

A

combo so conductive and sensorineural

77
Q

Barotrauma

A
78
Q

Traumav

A
79
Q

most common inner ear tumor

A
80
Q

most common external ear tumor

A

SCC-occlusion cholestoma growth of squamous epithelium in middle ear erodes ossicular chain

81
Q

Conductive loss Weber and Rene

A

Good ear AC>BC

Bad ear to bad ear BC>AC

82
Q

Sensorineural Weber and Rene

A
83
Q

Speech audiometry

Impedance audiometry

A
  • softest level someone can repeat 50% of words said
  • ex. tympanometry, stapedial reflex)
84
Q

Vestibulocochlear n. responsible for sense

A

hearing,

body position,

pertinent to balance,

transmits sounds and equilibrium info to brain from the inner ear

85
Q

•Schwann cell derived tumors arise from vestibular portion of _____ CN resulting in an _______ of Schwann cells

A

8th CN

overproduction of schwann cells

86
Q

pt presents w/ unilateral (asymmetric) sensorineural hearing loss.

ON physical exam:

  • Rinne not affected (AC > BC)
  • Weber is louder in good ear

dx

A

Vestibular schwannomas

87
Q

best initial screening test showing asymmetrical sensorineural hearing loss at high-frequencies

A

Audiometry - vest. schwanommas

88
Q
  • MRI w/ gadolinium
  • CT w/ contrast

are used to dz

A

Vestibular schwannomas

89
Q

Surgery options of Vestibular schwannomas (3)

A
  • Retromastoid suboccipital - any size tumor w/ or w/o attempted hearing preservation
  • Translabyrinthine – larger then 3cm and for smaller tumors when hearing preservation not an issue
  • Middle fossa – small <1.5cm tumors where hearing preservation is the goal
90
Q

Radiation options w/ vest. schwannomas

A
  • Stereotactic radiosurgery - single beam dose radiation
  • Proton bean therapy – deliver of high-dose radiation to target volume while decreading ”scatter” to surrounding tissue
91
Q

when can we observe scwannomas

A

C/I in pts w/ large tumors or brainstem compression) schwann slo growing follow up MRI in 6-12 mo

92
Q
  • Unilateral (asymmetric) sensorineural hearing loss
  • Tinnitus
  • Unsteadiness

Rinne not effected

dx

A

Vestibular schwannomas

93
Q

Mutation of the NF2 gene - inactivates TSG merlin

age of onset 20

A

NFT 2

94
Q

NFT presents similarly to Vestibular schwannomas they both:

  • Tinnitus
  • Unsteadiness

what differentiates them?

A

Vestibular schwannomas - unilateral hearing loss , normal rene, wber louder in affected ear

NFT 2bilateral hearing loss

95
Q

NFT2 predisposes the pt to multiple nervous system tumors – most common____ ______

A

bilvestibular schwannomas

96
Q

Injury to TM or other parts of the ear from failure to equalize pressure

A

ear barotrauma

97
Q

most common cause of ear barotruama

A

flyinf - shorter flights

98
Q

most common dz in divers

A

Ear barotrauma

99
Q

si/sx of ear barotruama

A
  • Ear pressure(most common)
  • Pain w/ stretching of the TM
  • Hearing loss
  • Tinnitus
  • Vertigo
100
Q

tx for ear barotruma

A
  • Self-limiting
  • Supportive care
  • Surgical tympanoplasty
101
Q

dx ear barotrauma

A
  • History and physical exam
  • Otoscopy for ruptured TM

Clin Med I Exam 3 Heme/ENT (3 decks)

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