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ENT Flashcards

1
Q

How does BCC on auricle present

How is it Tx

A

Nodular lesion that ulcers, bleeds but rarely metastasizes

Topical 5-Fluorouracil
Excision
Radiation
Mohs surgery

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2
Q

What are the words used to describe BCC of the auricle

SCC of auricle are present in ? PT populations w/ ? RFs

A

Bleeds Ulcerated Rolled edges Nodular Translucent
Pedunculated

UV radiation
Chemical exposure
Old males
ImmSupp 
Non-healing ulcer
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3
Q

What step is required upon Dx of SCC of the auricle

How does SCC look on presentation

How is SCC of the auricle Tx

A

Eval neck nodes

Plaque Ulcer Nodule that bleeds

Parotidectomy
Excision
Neck dissection
Mohs

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4
Q

What type of finding of malignant melanoma of the ear is indicative to chance of metastases?

How are they Tx?

A

<10% w/ thin
>90% w/ thick

Detect/excision
Possible lymph node dissection

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5
Q

What words may be used to describe auricular hematoma?

How are these Tx?

A

Fluctulant Edematous Ecchymotic Lost landmarks

Evacuate hematoma
Splint x 7days w/ f/u at 24hrs
PO ABX- Diclox/Cephalexin
Cipro- Staph/Pseudomonas
Refer if >7d old
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6
Q

Where is the anesthetic injection for local blocks placed prior to Tx?

? type of anesthetic block is best for Tx of auricular hematomas w/ least risk for tissue distortion?

A

3-4mL posterior sulcus, needle insertion inferior pole

Regional block- best for extensive lacs, needle inserted SQ 1cm above superior pole of auricle

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7
Q

How doe Peri/Chondritis present to clinic?

Usually indistinguishable, but what is the exception

A

Swollen, warm erythematous auricle tender to touch w/ pain on deflection

Chondritis doesn’t involve lobule

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8
Q

What is usually the infecting microbe of Peri/Chondritis

How are these Tx based on severity

A

P aeruginosa

Mild: PO FQN, f/u 24hrs
Mod-Sev: FQN + Aglycoside

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9
Q

What does the lateral/medial EAC contain?

A

Lateral third: cartilage section w/ hair and glandular skin

Medial: bony section w/ skin attached to periosteum of temporal bone

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10
Q

What landmark of the ear is the narrowing point of the canal?

What are the 4 main reasons cerumen impaction occur?

A

Isthmus

Failed migration
Overproduction
Narrowing
Obstruction- Crohns SLE Sjogren

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11
Q

Cerumenolytics can be used in ? PT populations

When is the use c/i?

If given to PT for at home use, do not give more than ? use

A

No Infection Hx Perforation or Otologic surgery

Suspected TM damage- otorrhea otalgia
Hx frequent ear infections

3-5 days

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12
Q

What post-cerumen irrigation step is important?

When do these impactions need to be referred to ENT for cleaning?

A

Visual exam
Acetic/Boric acid or alcohol- must do if ImmComp

TM perforation
Recurrent impaction
Routine Tx failure
Hx of OM/TM perf

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13
Q

What is the criteria of recurring symptomatic cerumen impaction?

When is irrigation not done for removing foreign bodies out of the ear canal?

How are live insects removed

A

> 1/year despite removal in other wise normal ear

Organics- beans, insects

2% viscous lidocaine

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14
Q

How does Otitis Externa present to clinic and on exam?

What happens to this if left untreated?

A

Erythema, edema in canal w/ exudate, painful w/ auricle manipulation

Osteomyleitis of skull base

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15
Q

Otitis Externa is AKA ? w/ ? two processes present due to ? microbes

What RFs place PTs at risk

A

Swimmer Ear- inflammatory, infection of EAC
Pseudo aeruginosa
Staph A

Scratching Lacking cerumen
Water Q-tips

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16
Q

How is a mild case of AOE Tx

How is a moderate case Tx

A

Isopropyl alcohol
White vinegar
2% Acetic Acid 5gtts TID/QID

Corticosporin: Polymyxin B, HCZ and Neomycin- sensitizer

Gentamicin Sulfate (A-glycoside): ototoxic, c/i if TM perf

Cipro/Ofloxacin: Quinolone if suspected perf is present

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17
Q

When do systemic ABX need to be used for AOE Tx in combo w/ ototopicals?

A

Cipro 500mg PO BID x 7d if any are present: CIDERS

Cellulitis ImmDef DM
Edema preventing topicals
Radiation Hx Severe OE

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18
Q

Why is Acetic acid use for mild AOE

When does this medication need to be avoided?

A

Pseudomonas and Staph A grow between 6.5-7.3pH

Painful exam/to touch

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19
Q

What is the worst case and most feared complication outcome of AOE that is due to ? microbe

What PTs are more likely to develop this worst case?

A

Necrotizing/Malignant Otitis Externa
Pseudomonas

Bacterial infection of EAC and skull base

DM ImmComp Elderly

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20
Q

How does Necrotizing/Malignant OE present?

What presentation is a poor prognosis?

How is Necrotizing/Malignant Otitis Externa Dx

A

Foul otorrhea
Otalgia, deep
Granulation

CN palsies: 6 7 9 10 11 12

CT w/ bone windows

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21
Q

How is Necrotizing/Malignant Otitis Externa Tx

How is it Tx if case is refractory to medical Tx

A

Daily anti-Pseudo drop/ABX
IV/PO Cipro
ENT refer

Surgical debrisment

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22
Q

Define Exostoses, it’s association w/ ? and it’s AKA

Define Osteoma

A

Reactive lamellar bone formation causing EAC lesions
Chronic cold exposure
Surfer Ear

Pedunculated EAC lesion of benign osseous neoplasms attached to tympano squamous/mastoid suture line

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23
Q

What are the essentials for Dx of Eustacian Tube Dysfunction

What are these PTs at risk for?

A

Fluctuating hearing
Aural fullness
Discomfort w/ barometric change

Serous/Effusion Otitis media

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24
Q

? is an easy way to assess TM integrity and eustachian tube patency

What are two other alternative methods

A

Valsalva

Otoscope bulb insufflation
Tympanogram

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25
Q

What are the 3 causes of dilatory dysfunction resulting in decreased ability to dilate

A

Inflammation:
MC- viral URI/allergies
Acid reflux
Pregnancy hormone 3rd-T

Pressure dysregulation from altitude changes

Anatomic abnormalities:
Masses
Atresia/stenosis
Trauma- surgery, intubation
Congenital: Downs Turners
Hypertrophic adenoid
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26
Q

Define Patulous Dysfunction

A

Overly patent Eustacian tube
PT ‘hears body functions’

Weight loss- 6lbs
Atrophy neuromuscular
Scarring
Hormones- pregnant, OCP, prostate Ca Tx

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27
Q

How are eustacian tube dysfunctions clinically dx?

What are the risk factors for developing ETD conditions

A

Dilatory: HL, TM retraction/effusions
Patulous: autophony, TM moves w/ respiration

Smoker
Infection Hx
Neuromuscular d/o
Child w/ cough
Reflux
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28
Q

How are eustachian tube dysfunctions Tx

A 
Dilatory:
Behavior mod/PPIs
Antihistamines
Nasal steroids
Decongestants
Frequent valsalva

Patulous:
Hydrate Educate Reassure
Nasal spray Surgery

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29
Q

What are the essentials of Dx for Serous Otitis Media

This condition is AKA ?

What PT population does it typically present in?

A

Prolonged ET blockage
Neg pressure= transudation

Otitis Media w/ Effusion

Peds w/ narrow/horizontal ET

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30
Q

How does Serous Otitis Media present

What is the best way to Dx

A 
Barotrauma
Adult w/ Hx of URI, Allergy, 
Dec TM mobility w/ bubbles
Aural fullness 
Conductive HL

Tympanometry

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31
Q

Adult PTs w/ persistent unilateral Serous Otitis Media >3mon need to have ? DDx r/o?

How is this Tx

A

Nasopharyngeal carcinoma w/ endoscopy

Mild HL: observe x 3mon

PE tubes
Endoscopic widening
Adenoidectomy: 
Relieves obstruction
Improves tube function
Simultaneous PT placement
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32
Q

What are the 9 indications to place PE tubes in PTs

A

HL >30dB w/ OME
SOM >3mon

Craniofacial abnormalities
Autophony from PET
Mastoiditis/intracranial issue
Prevent/Tx barotrauma
ETD w/ chronic retraction
Radiation/skull surgery causing middle ear dysfunction
Severe/recurrent AOM
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33
Q

What are the essentials of Dx for AOM

What are the cardinal signs of inflammation that may be seen?

A

Hypomobility
Otalgia w/ URI
Erythema

Heat Redness Pain Loss of function Swelling

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34
Q

AOM is a sequelae of ?

What are the two MC illnesses affecting kids?

A

ETD w/ inflammation narrowing the tube causing throat reflux into tube

URI, OM

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35
Q

How does OM present to clinic?

How is it Dx

A

Dec hearing/pressure
Mastoid tenderness
Sudden otalgia/fever

PE findings
Pneumatic otoscopy

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36
Q

What are the MC microbes causing AOM?

How is this Tx

A

H influenzae
Strep pneumo
*Strep pyogenes- GABHS

Observe: >2y/o, <102.2 fever, healthy w/ mild case
ABX Antipyretic Ibuprofen/Acetaminophen
Spontaneous resolution <72hrs

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37
Q

When are ABX used for AOM

Which ones are used?

A

Adults
Kids <2y/o or no improvement >72hrs of observation
Severe Sxs

Amoxicillin- first line
Augmentin- resistant cases

PCN allergy:
Mild/Mod: Cefdinir/Ceftriax
Severe: Erythro + Sulfonamide

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38
Q

Define SNAP Approach to OM

What is the MC Sx of OM

A

Safety Net approach ABX Prescription:
Paper Rx, only if child does not improve/worsens

Ear pain, Tx w/ Ibuprofen/Acetaminophen

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39
Q

How does an Amoxicillin rash present

What PT education piece goes w/ this presentation?

What f/u test needs to be ordered?

A

Itchy maculopapular rash >72hrs after taking meds, spreads from trunk

Rash is not indication of future c/i ABX use

90% of PTs w/ EBV infection Tx w/ Amox develop rash, order Monospot

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40
Q

Pts w/ AOM that are ImmComp or persistently have recurrent infections needs ?

Why do so many Peds PTs have cycles of repeat AOM?

A

Tympanocentesis for culture
Myringotomy if severe otalgia, mastoiditis, meningitis occur

Fluid remains in ears x 10wks in 10% of population, progression to chronic OM

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41
Q

Criteria for recurrent AOM

How are these cases Tx

A

3 or + Dx of AOM <6mon or,
4 or more w/in 12mon

PE tubes

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42
Q

Define COM

What microbes can cause this?

A

Chronic otorrhea through perforated TM w/ mucus and bone changes

Pseudomonas Anaerobes Proteus Staph A

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43
Q

What is the hallmark presentation for COM?

What is an uncommon presenting complaint?

What type of hearing loss can present

A

Purulent d/c w/ inc severity during URI/after water exposure w/ TM perf

Pain unless during exacerbation

CHL, destruction of ossicles and/or TM

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44
Q

How is COM Tx

A

Refer for debris removal

Oflo/Cipro w/ Dexameth drops
PO Cipro BID x 6wks

Mastoidectomy

Ear plug use

Surgical TM repair

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45
Q

What complications can arise from COM

A

Facial paralysis
Otogenic meningitis

Perforated TM
Cholesteatoma
Mastoiditis

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46
Q

How are TM perforations Tx

What drugs must be avoided?

A

Combo PO and Topical ABX:
Ofloxacin/Cipro HC
PO ABX if infected

Polymyxin/neomycin ETOH
Aminoglycosides Water

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47
Q

What are the 3 layers of the TM

? type of disruption leads to a chronic perf that then needs to be Tx by ?

A

Squamous epithelium (outter)
Collagen fibrous
Cuboidal in middle ear

Squamous and cuboidal junction meet, causes fibrous layer to stop growing
Tympanoplasty

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48
Q

Define Cholesteatoma

What type of destruction can this lead to?

A

Prolonged ETD w/ negative pressure causes TM retraction (pars flaccida)

Osteoid destruction
Intracranial spread
CN8 involvement

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49
Q

How does Cholesteatoma present

What is the imaging modality of choice for this condition?

How are Cholesteatomas Tx

A

TM retraction
Perf w/ keratin/granulation
Chronic draining ear

CT/MRI if post-op

Surgical excision, ETD remains
PE tube

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50
Q

How does mastoiditis present

What is the next step if this is suspected

A

Inadequeatley Tx AOM/COM in Peds w/: Fever
Posterior ear pain
Auricle displacement
Pinna edema

CT
Positive= coalescence of mastoid air cells from bone destruction
Immediate ENT referral

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51
Q

What microbes are most likely to cause mastoiditis?

How is it Tx

How are PTs Tx that are ABX failure?

A

Strep pneumo
H influenza
Strep pyogenes

IV Cefazolin

Myringotomy for culture
Mastoidectomy- definitive

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52
Q

Define Petrous Apicitis AKA Petrositis

What is the classic Triad

A

AOM infection spreads through temporal bone into petrous apex

Gradenigo Syndrome:
CN 6 paralysis
AOM
Retro-orbital pain

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53
Q

How is Gradenigo Syndrome Dx

Facial palsy can also be associated w/ ?

A

Clinical exam
X-ray shows bone destruction in petrous apex

AOM inflammation of CN7
COM pressure of CN7 from cholesteatoma

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54
Q

How is facial paralysis from AOM Tx

How is it Tx if from COM?

A

Myringotomy and IV ABx

Surgicaly correct cholesteatoma, poorer prognosis

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55
Q

? is the MC intracranial complication of ear infections

How is it Tx

What is a severe but uncommon complication due to untreated AOM

A

Otogenic meningitis from severe/neglected AOM

Myringotomy

Brain abscess

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56
Q

Define Tympanosclerosis

What can cause this to happen?

How is tympanosclerosis Dx

A

Hyaline/Ca deposits in TM leading to CHL

PET Injury Chronic dz

Pneumatic otoscopy shows decreased mobility

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57
Q

Define Otosclerosis

How is Otosclerosis Tx

A

Familial tendency, abnormal bone growth on stapes foot plate causing 60dB HL

Observe Amplify Stapdectomy

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58
Q

How can ear barotrauma be prevented?

When do they need to be referred to ENT?

A

Pseudophedrine hrs before descent
Oxymetazoline 60m before descent
Tubes if PT must travel often

> 4 days HL Vertigo Blast injury
Severe otalgia

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59
Q

When does disruption to the ossicular chain need to be suspected in PTs after middle ear trauma?

How is it Tx

A

CHL >30dB x 3mon

Surgical exploration and reconstruction

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60
Q

Primary middle ear tumors are rare, but what kind can develop?

How does this present in clinic?

How are they Tx

A

Glomus tumors in middle ear or in jugular bulb w/ erosion into hypotympanum

Pulsatile tinnitus w/ CHL
Vascular mass behind TM
CN 7 9-12 defects

Surgery/radiotherapy

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61
Q

If PT has suspected middle ear neoplasia w/ pulsatile tinnitus, what imaging study is warranted?

What are the MC causes of ear aches that need to be r/o?

A

MRA and venography to r/o vascular masses

OE, AOM

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62
Q

What could cause PT to present w/ ear aches w/ Pain OOP

Why/how does referred otalgia occur?

A

Herpes zoster oticus

Sensory innervation from CN 5 7 9 10
TMJ dysfunction

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63
Q

Define Bruxism and what does it mean for ear pain

How are these PTs Tx

A

TMJ pain exacerbated by chewing from dental malocclusion

Heat/NSAID
Dental refer
Soft food

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64
Q

What are types of non-otologic causes of ear aches?

What presentation indicates this Dx and how is it Tx

A

Glossopharyngeal neuralgia- repeated severe lancinating otaliga- pain in throat/in ear

Refractory to medical management
Microvascular decompression of CN9

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65
Q

Define Perilymph

Define Endolymph

A

Fluid similar to perilymph that surrounds labyrinth

Fluid inside labyrinth w/ high K+ content w/ role in auditory signal generation

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66
Q

? part of the ear play roles in situational awareness and location in space?

? is the important component to balance control?

A

Semi-circular canal

Vestibular system

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67
Q

Difference between Vertigo and Dizziness

What can cause dizziness?

A

All vertigo is dizzy
Not all dizzy is vertigo

Vertigo
Pre/Syncope
Disequalibrium
Non-specific light headed

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68
Q

Define Vertigo

Wat is an important part of making this Dx

A

Sensation of motion where there is none of exaggerated sense of motion in response to movement

Duration
+/- HL

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69
Q

Vertigo can be caused from asymmetry of the vestibular system due to damage/dysfunction of ?

Otolaryngologists focus on Dz processes that cause vertigo due to ? causes while Neurologists focus on ? causes

A

Labyrinth
Vestibular nerve
Vestibular structure in brain stem

O: Peripheral
N: Central

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70
Q

Define Peripheral Vertigo

Define Central Vertigo

A

P: dysfunction of labyrinth or vestibular nerve
Sxs: Severe, sudden

C: dysfunction of balance center in brainstem or cerebellum
Sxs: mild/neuro deficit
Brain pathology causes disequalibirum

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71
Q

What are etiologies of Peripheral Vertigo

A 
Meniere dz
Vestiubular/babyrinth-itis
Inner ear barotrauma
Benign position vertigo
ETOH 
Semicircular canal dehiscence
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72
Q

What are etiologies of Central Vertigo

A 
Stem/Cerebellar tumor
Seizure
Wernicke
A/V malformation
MS
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73
Q

? type of diet can cause vertigo

+ Romberg is indicative of ? underlying issue

A

High Na

Central cause of vertigo

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74
Q

What meds can cause vertigo?

A 
Aminoglycoside
Tranquilizer
Tobacco
Anti-HTN
Caffeine
Hypnotic 
ETOH
Diuretic

Anticonvulsant
Analgesic
Phenothiazine
Antidepressant

Diuretic
Vasodilator
Dopaminergic

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75
Q

When assessing vertigo, evidence of brainstem involvement r/o ? but ?

If vertigo is persistent or suspected CNS Dz is present, evaluate PT w/ ?

A

R/o peripheral lesion
Absence of brain stem involvement doesn’t r/o central lesion

Brain MRI
Audiogram
E/VNG

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76
Q

? test is used to discriminate between central and peripheral vertigo etiologies

What is the caloric stimulation used for?

A

ENG: electrodes record eye movement
VNG: video record eye movement

Vestibulo-ocular reflex for vestibular d/o
Norm= COWS, cold-opposite, warm same

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77
Q

? type of nystagmus may be seen in peripheral etiologies of vertigo

What can PT do to suppress this type of nystagmus

A

Horizontal w/ rotary
Fatigable
Latency

Visual fixation

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78
Q

Meniere Syndrome is AKA ?

What is believed to cause this syndrome

A

Endolymphatic Hydrops

Secondary to distension of endolymphatic space in inner ear

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79
Q

What is the classical Dx for Meniere Syndrome

Although etiology is unknown, what are two known causes of this syndrome?

A

Sensory neural HL
Episodic vertigo
Tinnitus, low tone/blowing
Sensation unilateral aural fullness

Syphilis Trauma

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80
Q

What two tests are conducted when evaluating Meniere Syndrome

What meds can be used for Sx relief

What can be done for cases that are refractory to Tx

A

Audiometry
Caloric Testing

Acute: PO Meclizine/Valium
Primary: low Na diet, Acetazolamide

Intratympanic CCS injection
Vestibular ablation
Endolymph decompression

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81
Q

What is the difference between vestibular neuritis and labyrinthitis?

What is the believed etiology?

A

V: no hearing loss
L: unilateral SHL

Inflammation of vestibular nerve/labyrinth from viral URI

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82
Q

How does labyrinthitis usually present?

How is it Dx

What will be seen on PE?

A

PT wakes w/ room spinning vertigo that decreases over days

Clinical

Spontaneous horizontal nystagmus
Post head thrust test

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83
Q

How are Sxs from labyrinthitis Tx

Define BPPV and what causes it

A

Benzo- Meclizine/Diazepam
Antihistamine
Rehab after acute Sxs stop

Benign Paroxysmal Position Vertigo from otoconia (Ca Carbonate crystals) free floating in semicircular canals

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84
Q

How does BPPV present

What type of precipitating event frequently causes this presentation

A

Quick movement causes sediment in endolymph to stimulate vestibular nerve

Rolling over in bed

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85
Q

What type of PE test is used for assessing BPPV

This test will provoke a response if ? type of dysfunction is present

A

Dick Hallspike maneuver

Posterior canal

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86
Q

How is BPPV Tx

? med can be used for vertigo during pregnancy

? drug class is DOC for vertigo overall?

A

Epley particle reposition maneuver- debris moved to common crus of ant/post canal, exits auricular cavity

Meclizine

Antihistamine

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87
Q

? is the MC cause of vertigo after a head injury

How does a basilar skull Fx present differently

A

Labyrinthe Concussion

Severe vertigo w/ deafness in involved ear

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88
Q

Chronic post-traumatic vertigo can be a result of ?

How are cases of traumatic vertigo Tx

A

Cupulolithiasis- BPPV

Diazepam/Meclizine
Vestibular therapy

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89
Q

Define Perilymphatic Fistula

How do these present

A

Inner ear barotrauma causing leakage of perilymph fluid into middle ear

Vertigo worse w/ straining
Sensory HL

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90
Q

Perilymphatic fistula can be a s/e of ? surgery

How is this Tx

What is done if case is refractory?

A

Stapedectomy

Bed rest w/ elevation
Avoid straining

Tissue graft window seal

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91
Q

? is a mixed peripheral and central etiology of vertigo

How does this form present to clinic?

A

Migrainous

HA
Visual/motion sensitivity
Phono/photo phobia
Worse w/ sleep deprivation/stress

92
Q

What type of Hx is usually seen in PTs w/ migrainous vertigo

What are possible dietary triggers?

A

Motion intolerance as Ped

Caffeine
Alcohol
Chocolate

93
Q

How is migrainous vertigo Tx

How does this differ from Meniere Dz

A

Lifestyle mod
Anti-migrain prophylactic

No HL or Tinnitus

94
Q

Define Semicircular Canal Dehiscence

How does it present

A

Deficiency in bone covering superior semi-circular canal

Vertigo from loud noise or straining w/ CHL

95
Q

What is different about central vertigo nystagmus compared to peripheral induced?

If central vertigo is suspected where are they referred to?

A

Central: non-fatigueable and vertical w/out latency and non-suppressable

Neurology

96
Q

Dzs of central auditory and vestibular systems include lesions on CN? and can cause ?

What studies are ordered for evaluation?

What 3 d/os does this include?

A

CN8 lesion
Neural HL w/ vertigo
Deteriorated speech

BAER- differs cochlear from neural loss
MRI

Vestibular Schwannoma- acoustic neuroma
Vascular compromise
MS

97
Q

Define Acoustic Neuroma/Vestibular Schwannoma and where most are located

These growths usually start ? and grow into ?

A

Sheath tumor on CN 8
Unilateral

Start: internal auditory canal
End: cerebellopontine angle

98
Q

How do Acoustic Neuromas present

How are they Dx

How are they Tx

A

Unilateral SNHL
Disequalibrium

MRI w/ contrast

ASx: observe
Sx: excise, radiation
Annual MRI

99
Q

How does MS present similar to Meniere’s

A 
Unilateral SHL
Facial numbness
Episodic vertigo
Chronic imbalance
Hyper/hypoacusis
Diplopia
100
Q

How do cases of vertebrobasilar insufficiency present?

How are they empirically treated?

A

Vertigo w/ changes in posture or neck extension

ASA
Vasodilators

101
Q

What type of vertigo prevents PTs from getting better even w/ therapy?

What are the two types of hearing loss

A

Bilateral Vestibular

Conductive: external/middle ear dysfunction
Sensorineural: cochlea deterioration, CN8 lesion

102
Q

What are the 5 classifications of HL and dB equivalent

A

Normal: soft whisper, 0-20

Mild: soft spoken, 20-40

Mod: normal spoken, 40-60

Sev: loud spoken, 60-80

Profound: shout, >80

103
Q

Define how Weber test appear on PE w/ different HL types

How does Rinne appear on PE for different HL types

A

R ear CHL, Weber better R
R ear SNHL, Weber better L

R ear CHL, BC>AC
R ear SNHL, AC>BC, same pattern for normal hearing

104
Q

Define CHL

What are the 4 causes of this type of hearing loss

A

Dysfunction of external/middle ear w/ impaired sound passage to inner ear

Mass
Obstruction- impaction MC
Discontinuity
Stiffness

105
Q

Transient CHL is usually due to ?

Presistent CHL is usually due to ?

How are they Tx

A

Cerumen impaction- MC
ETD from URI

Chronic ear infections
Otosclerosis
Trauma

Tx infection/impaction
Tympanoplasty
Prosthesis

106
Q

What causes sensory HL

What causes neural HL

Usually bilateral, what does unilateral SNHL mean?

A

Deterioration of cochlea, irreversible

Lesions of CN8 or higher

Lesion proximal to cochlea (acoustic neuroma)

107
Q

What are the 7 etiologies of SNHL

Sounds above ? dB injure cochlea?

A 
Presbycusis- inc age, MC
Hereditary 
Noise 
Sudden 
Ototoxicity 
Autoimmune 
Physical

> 85dB

108
Q

Characteristics of Age Related HL

What is the MC complaint on presentation

A

MC cause
High frequency, symmetric
Hard hearing bird/phone

Loss of speech discrimination in noisy environments

109
Q

? is the 2nd MC cause of SNHL

What is the first issue noted in these PTs

A

Noise/physical trauma

Loss of high frequencies >4KHz

110
Q

Ototoxic substances affect ? and ?

? is the MC ototoxic med

A

Auditory and Vestibular

Aminoglycosides
Loop diuretics
Antineoplastics

111
Q

How can the risk of ototoxicity be reduced?

What usually is the cause of sudden unilateral hearing loss in PTs >20y/o

How is it Tx

A

Serial audiometry
Peak/trough levels
Non-ototoxic drugs

Viral infections
Vascular occlusions of internal auditory artery

PO CCS/Intratympanic injection ASAP, worse if >6wks after onset

112
Q

What are 3 autoimmune d/os that can cause SHL

How does it present in PTs

A

SLE
Granulomatosis w/ polyangitis
Cogan Syndrome: hearing loos, keratitis, aortitis

Wax/waning loss leading to permanent hearing loss

113
Q

What labs are ordered for PTs w/ suspected autoimmune induced SNHL

What first and second line meds may be used?

A

ANA RF ESR

PO CCS
Methotrexate

114
Q

? Sx usually indicates presence of SNHL

What are two types of this Sx that may present

A

Tinnitus

Pulsatile- abnormal, possible CHL; get MRA/V
Staccato: clicking, middle ear muscle spasm

115
Q

Define Palatal myoclonus

Other than noise avoidance, white noise and behavior mod, what medication can be used for these PTs

A

Rhythmic involuntary movement of soft palate associated w/ staccato tinnitus

Notriptyline

116
Q

Define Hyperacusis

What can cause this

How is this Tx

A

Excessive sensitivity to sound in PTs w/ normal hearing

Migraine Hx Ear dz
Psych

Ear plugs
Habituation

117
Q

What are the evaluation goals for HL

A 
Configuration
Degree 
Anatomy of impairment
Type 
Etiology
118
Q

Sudden hearing loss is usually due to ? and PTs complain of ?

Gradual hearing loss is usually due to ? w/ ? complaints

A

Viral infection
Vascular occlusion
Poor sound localization, difficulty hearing w/ background noise

Otosclerosis
Vestibular schwannoma
Menieres dz

119
Q

How do vestibular schwannomas present?

? HEENT PE finding is indicative of immediate referral to ENT

A

Large= CN 5/7neuropathy
Asymmetric hearing loss
Tinnitus
Imbalance

Unilateral serous effusion in adult PT

120
Q

Audiology assessment includes ? 4 parts

All PTs w/ hearing loss get ? unless ?

A

Pure tone air/bone conduction (audiogram)
Acoustic reflex
Speech reception
Tympanometry

Refer to audiology exam
Impaction/OM etiology

121
Q

Audiology assessment measures thresholds between ? range

Thresholds above ? are abnormal

A

250-8000Hz

> 20dB

122
Q

Pure tone test is AKA ?

OSHA definition of STS

A

Audiogram

10dB or more at 2-4000Hz
Sum of shift 2-4000 >30dB

123
Q

Define Tympanometry

What is this particularly good for detecting?

A

Evaluates TM and middle ear status

Assesses TM mobility in response to pressure changes

Middle ear fluid

124
Q

What do the X and Y axis of a tympanometry indicate

Type A Tymapnogram

A

X: pressure against TM
Y: movement of TM

Peak curve near 0 daPa
Peak compliance .2-1.8
Absence of middle ear pathology
If HL present, SNHL

125
Q

Type As Tympanogram

Type Ad Tympanogram

A

Shallow, peak near 0 but dec compliance below 0.2
Associated w/ ossicular fixation, otosclerosis or TM scars
Flat, non-fluctuating HL
Normal ET function

Peak near 0, normal
Peak pressure above 2.0
Indicates ossicular disarticulatio/discontinuity
Peak compliance very high
Flat, non-fluctuating HL
Normal ET function
126
Q

Type B Tymapnogram

Type C Tympanogram

A 
Flat, poorly mobile
Peak absent/poorly defined w/ neg middle ear pressure
Little/no TM movement
Compliance below normal
Indicates middle ear fluid/TM perf

Retracted TM/ETD
Peak falls on negative side d/t middle ear neg pressure
Normal peak compliance
ET dysfunction, mild CHL or normal hearing

127
Q

What two sinuses are not well developed in small kids?

Define the Ostiomeatal Complex

A

Frontal Sphenoid

Channel linking frontal sinus, anterior ethmoid and maxillary sinus to middle meatus
Allows air and mucus drainage

128
Q

How is acute viral rhinosinusitis Tx

Why are these drugs only used for 3 days max?

A

Buffered Hypertonic Saline
PO Decongestants:
Pseudophedrine
Oxymetazoline and phenylephrine

Rhinitis medicamentosa- rebound congestion

129
Q

What is the difference in presentation between viral and bacterial rhinosinusitis

What does bacterial infections occur?

A

V: clear
B: yellow/green, facial pain

Largest complex in middle meatus clogs, secondary bacteria infection starts

130
Q

What microbes cause community acquired ABRS

What microbes cause Hospital acquired ABRS

A

Strep Pneumo
H influena
Staph A
M catarrhalis

P aeruginosa
Gram negs
Staph A

131
Q

What is an important distinction to tell PTs about AVRS or ABRS

How does the IDSA recommend IDing ABRS

A

Viral improves 7-10 days

Sxs x 10d w/out improving
Severe Sx/fever >102 w/ nasal d/c x 4d
Worsening Sxs after initial improvement (double sick)

132
Q

What are the 4 classifications of ABRS?

A

Acute <4wks

Subacute 4-12wks

Chronic >12wks

Recurrent 4 or + episodes per year w/ Sx resolution

133
Q

Paranasal sinusitis MC presents as ?

How does is commonly appear on PE

A

Acute maxillary sinusitis, larger, easily obstructed

Pressure
Unilateral facial fullness
Tenderness over cheek
CN5 pain= dental infection

134
Q

? type of sinusitis usually accompanies maxillary sinusitis w/ pain/pressure over high lateral wall of nose between eyes and radiates to orbit

How does Sphenoid Sinusitis present

How does Frontal Sinusitis present

A

Acute ethmoid sinusitis

Pan-sinusitis- HA in middle of head

Pain on forehead

135
Q

Hospital associated sinusitis is associated w/ presence of ?

? image modality is used in acute rhinosinusitis cases and when

A

Prolonged NG tube placement

CT if Tx failure or pre-op work up

136
Q

How is ABRS Tx

If ABX is used, which one is and is NOT used

A

PO Pseudophedrine
Intranasal CCS- Mometasone fuorate
NSAID/Acetaminophen
Topical decongestants

Use:
Augmentin- first line
PCN allergy- Doxy
Clinda + Cefixime
No: Macrolide, TMP/SMX
137
Q

Initial ABRS Tx includes observation for mild Sxs and temp <101, when does this change to use ABX?

What complications may arise

A

Persistent Sxs >10days
Severe Sxs
Sxs worse after improving

Orbital cellulitis/abscess
Osteomyelitis- MC in frontal sinus

138
Q

What condition creates Pott Puffy Tumor?

What is a rare complication that can arise from ABRS?

What are the S/Sxs of this complication

A

Osteomyelitis from frontal sinusitis complications

Intracranial extension from hematogenous spread (Cavernous Sinusthrombosis
Meningitis), confirm w/ MRI for Danger Triangle

Severe HA AMS Fever

139
Q

When are ARBS PTs referred?

A 
PO ABX failure
Sxs >12wks
Dz extends out sinus cavity
Facial swelling/erythema
Proptosis
ImmComp
140
Q

Define Nasal Vestibulitis and it’s cause

How is it Tx

A

Inflammation from infect nasal vestibule d/t folliculitis from Staph A

Dicloxacillin w/ Mupirocin
InD
Chlorhexidine washes

141
Q

Define Rhinocerebral Mucomycosis

Although presentation is similar to other sinusitis, how is this different?

A

Invasive Fungal Sinusitis- fungal infection in ImmComp PT w/ Asperigllus/Mucor

Severe facial pain

142
Q

How does Rhinocerebral Mucomycosis classically present on PE

Early Dx requires biopsy which will show ?

A

Black eschar on middle turbinate

Silver stains- branching nonseptate hyphae

143
Q

? is the DOC for Tx of Rhinocerebral Mucomycosis

? antifungals may be used

What surgical procedure is done?

A

Amphotericin B

Varizonazole
Caspofungin

Medial maxillectomy

144
Q

? three PT populations have the highest morality rates due to Rhinocerebral Mucomycosis

? is the source of allergies from dust mites?

A

AIDS/malignancy w/ neutropenia- 100%
CKDz >50%
DM 20%

Protein in feces/decaying bodies

145
Q

? is the mainstay of Allergic Rhinitis Tx

What PT education piece has to be given

A 
Intranasal CCS:
Beclomethasone
Flunisolide
Mometasone
Budesonide
Fluticasone propionate

Target middle turbinate, not septum

146
Q

? other meds can be used in the Tx of Allergic Rhinitis other than CCS

How are these others broken up by sedation ability

? is used if PT is intolerant to s/e of PO meds

A

PO antihistamine H1 blockers

Sedation:
Non: Lorat/Deslorat/Fexofenadine
Min: Cetirizine
Most: Bromophen/Chorpheniramine

Azelastine spray

147
Q

What adjunctive meds can be added to the Tx of Allergic Rhinitis

? is the most effective way to alleviate Sxs of this condition

A

Montelukast
Mast cell stabilizer Corolyn Sodium (most useful optho)
Sodium Nedocromil

Reducing/avoiding exposures

148
Q

What are the 4 types of non-allergic rhinitis

What meds can be used to help Afrin PTs during d/c and prevent rebound congestion

A

Gustatory- hot/spicy foods
R. Medicamentosa- rebound
Vasomotor- hyper activity
Occupational- fumes

Flunisolide
Ipratropium
Prednisone
NSAID

149
Q

Nose bleeds MC occur from ?

Nose bleeds from ? source are more severe due to violation of ? structure from ? RFs

Most can be Tx w/ ?

A

Uliateral anterior cavity from Kiesselbach plexus

Posterior, Woodruff plexus
Atherosclerosis
HTN

Pressure x 15min

150
Q

What are the Tx steps for anterior nose bleeds

A

Don PPE
Direct pressure x 15min while sitting and leaning fwd

Still bleeding after 15min, Phenylephrine/Oxymetazoline then 15m more pressure

Still bleeding, reapply Oxymetazoline and -caine
Cautery w/ silver nitrate/electrocautery

Still bleeding, pack

151
Q

If packing nose to help stop epistaxis, what is the packing covered in first and why

How are posterior nose bleeds Tx

A

ABX ointment, reduces toxic shock syndrome

Pneumatic tamponade
Packing
Double balloon
Admit and monitor for potential need to surgically ligate

152
Q

After packing nose for epistaxis Tx, what ABX is needed?

? pain meds are given for posterior packings?

A

Anti-Staph

Opioids

153
Q

If septal hematoma is ID’d after nasal trauma, how long is packing left in place for after InD

What are the 3 levels of LaFort Fxs

A

2-5 days w/ Cephalex/Clinda

I: horizontal maxiallary Fx
II: pyramidal maxiallary Fx
III: craniofacial dysjunction

154
Q

PTs w/ nasal polyps usually have a Hx of ?

? event can precipitate these PTs having bronchospasms

A

Asthma

ASA

155
Q

Define Samter Triad

If this is discovered in a child what Dz needs to be r/o

How are nasal polyps Tx

A

Asthma triad

Cystic fibrosis

Topical CCS
Prednisone
Surgery

156
Q

Benign nasal tumors are AKA ?

What causes these growths

They need to be removed to prevent development into ?

A

Inverted/Schneiderian papillomas

HPV

SCC

157
Q

? is the best imaging prior to surgery for nasal Ca removal

Granulomatosis w/ Polyangiitis is AKA ? and defined as ?

What will be seen on PE and Dx biopsy results?

A

MRI

Wegeners- blood vessel dz of nose and paranasal sinuses

Crust/friable mucosa
Necrotizing granul/vasculitis

158
Q

What will be seen on PE and biopsy results if PT has Sarcoidosis

Define Lethal Midline Granuloma

What will be seen on PE and biopsy results

A

Turbinates w/ engorged white granulomas
Non-caseating granulomas

Polymorphic reticulosis, type of lymphoma

Nasal bone destruction
Nasal T cell/NKC lymphoma

159
Q

? is the best known precancerous lesion in the mouth

How does this MC present on PE

A

Leukoplakia

White patches that can’t be removed, represents hyperplasia of squamous epithelium

160
Q

What is the sequence of cellular changes in leukoplakia

This can also be seen in ? non-Ca conditions

A

Hyperplasia Dysplasia Insitu Invasive tumor

Hyperkeratosis from irritation- denture, tobacco

161
Q

Define Erythroplakia

How is this different from leukoplakia

A

Leukoplakia but more erythematous

More likely to exhibit dysplasia or microscopic carcinoma

162
Q

If erythro/luekoplakia is found, what is the next step?

When is consult for biopsy warranted

A

Palpate neck nodes, adenopathy= FNA

Presence >2wks

163
Q

? is the MC PO cancer

How does it present

What is the biggest RF

A

SCC

Non healing ulcer/mass

Alcohol/Tobacco, especially if combined

164
Q

Define Melanosis

Define Melanotic macules

A

Symmetric pattern of dark skin in DPP

Symmetric w/ sharp border discoloration in adults

165
Q

Define Amalgam Tattoo

Where is MC seen

What is the key component to Dx

A

Black/blue mark near silver amalgam material

Mandibular arch

Visualization of amalgam

166
Q

Define Fordyce Spots

Where/how do they present on PE?

A

Benign neoplasms of sebaceous gland etiology

Vermillion/buccal mucosal border as scattered papules 1-2mm

167
Q

Define Mucocele

Where are the MC seen

A

Fluid filled cavity w/ mucus glands lining epithelium

Lower lip from biting

168
Q

Define PO Lichen Planus

What are the two types and how are they differentiated

How is this Dx and Tx

A

Waxing/waning of inflammatory conditions from immune mediated responses

Reticular- painless wickham striae
Erosive- tender erythema w/ radiating striae

Dx: biopsy
Tx: Topical and Systemic steroids, Cyclosporines and Retinoids

169
Q

? is the first manifestation of HIV infections

What are the two types

A

PO Candidiasis, Thrush

Pseudomembranous: MC, white plaques
Atrophic- AKA denture stomatitis, erythema w/out plaques

170
Q

How are infants w/ thrush Tx

How are refractory cases Tx

A

Topical antifungal
Nystatin suspensions

Gentian violet
PO fluconazole

171
Q

How is Thrush Tx in older kids

How are adults Tx

A

Mild, <50%: Topical nystatin
Clotrimazole
Sev, >50%: Systemic fluconzaole

Fluconazole
Ketoconazole
Nystatin rinse
Chlorhexidine for Sx Tx

172
Q

? is the MC oral ulcer

What is believed to be the etiology

A

Recurrent aphthout stomatitis
on non-keratinized mucosa

HHV-6
Celiac/IBD
B/Fe/Folic/Z deficiency

173
Q

How are recurrent aphthous uclers Tx

How can lip herpes Dx be confirmed

A

Traimcinolone/Fluocinonide
Amlexanox
Diclofinac
Severe pain- Predinsone

Multinucleated giant cells on Tzanck smear

174
Q

How does Varicella-Zoster of the PO cavity present

Define and what causes atrophic glossitis

How does it present?

A

Vesicles and erosion in PT w/ chicken pox Hx

Inflammatory d/o of tongue leading to papillae atrophy
Fe/B12/Folic deficiency
Sjogren/Candidiasis
Malnutrition/Celiac dz

Burning when eating acid/salty foods

175
Q

What d/os are associated w/ geographic tongues

What are the 4 grades of tonsil sizes

A

Candidiasis
Psoriasis
Reiter syndrome
Lichen planus

0- removed
1- hidden behind pillars
2- extend to pillars
3- beyond pillars
4- extend to midline
176
Q

What is the Centor Criteria

What do score cut off mean for the next step

A 
3/4= 90% chance of GAS
Fever >100.4
Anterior adenopathy
No cough
Exudative tonsils
Modified: <15, >44

2: rapid Ag test
3 or more: rapid Ag test/empiric Tx

177
Q

What does Mono look like on PE

MC cause of pharyngitis is ? and presents as ?

A

Petechiae
Adeonpathy
White/purple tonsil exudate

Viral- cough rhionrrhea w/out exudate

178
Q

How does Diphtheria present on PE

When is GABHS Tx w/ ABX

What is the DOC

A

Pharyngitis
Malaise
Gray pseudomembrane exudate

Sx and confirmed culture

Pen VK
Amoxicillin- better taste for kids

179
Q

How is GABHS Tx

A

Ault:
PVK- DOC
IM Benzathine Peng G- noncompliant

PCN sensitivity:
Azith/Clinda

Kids:
PVK
Bicillin

PCN sensitivity:
Azith

180
Q

How is Mono Tx

What limitation is PT placed on

A

Analgesis
NSAID
Lozenge
CCS if significant edema

Splenomegaly profile

181
Q

Define Quinsy Tonsil

How is it Dx

How are they Tx

A

Peritonsilar cellulitis/abscess
Hot potato voice

US/CT

Cellulitis: Amox/Clinda
Abscess- Aspirate/InD
Admit for tonsilectomy

182
Q

What are the guidelines for tonsilectomy?

What are the two salivary ducts and their location

A

1-18y/o w/ watching best if:
<7 episodes in past year
<5 per year x 2yrs
<3 per year x 3 yrs

Parotid- stenson
Submandibular- wharton

183
Q

Define Sialadenitis

How is it Tx

A

MC Staph A infection causes swelling/pain w/ meals

Sialagogues
Severe: Nafcillan

184
Q

Define Suppurative Parotitis

How does it present

A

Staph A infection of parotid gland due to dehydration/poor hygiene

Stenson duct purulence
Fever/chills
Pain down angle of mandible

185
Q

How is Suppurative parotitis Tx

Define Sialoithiasis

A

Immediate refer
IV Nafcillin/Clinda
Vanc if ImmComp

MC Wharton duct w/ post-prandial pain and swelling

186
Q

When CT imaging sialothiasis cases, what will be seen in relation to location and size

How are these Tx?

A

Wharton: large, paque
Stenson: small, lucent

<2cm from opening- massage and extract
>2cm, sialoendoscopy, especially if chronic

187
Q

Most salivary gland tumors are in ? duct

Tumors that are small are more likely to be ?

When is the concern for parotid gland malignancy increased?

A

Parotid gland w/ medial deviation of soft palate

Adenoid cystic carcinoma

CN7 affected

188
Q

How are salivary gland tumors Dx and Tx

Framework of the larynx is composed of ? 6 cartilages?

These are innervated by ?

A

CT/MRI
Excise/FNA by ENT

Cricoid Thyroid Arytenoid
Epiglotic Corn Cune

Superior/Recurrent laryngeals

189
Q

When producing voice, what structures move together?

How is pitch controlled?

A

Arytenoid cartilage

Tension, tighter- higher

190
Q

? produces vowel sounds

Why do males have lower voices

? produces enunciation

A

Pharynx muscles

Larger/thicker folds from androgens

Face/Tongue/Lips

191
Q

Primary Sxs of laryngeal dz

Which one of these lasting longer than ?wks needs referral

A

Hoarse, Stridor

Hoarseness

192
Q

MC cause of hoarseness

What microbes usually cause this MC

A

Acute laryngitis <3wks

M catarrhalis
H Influenza

193
Q

Criteria for chronic laryngitis

What usually causes this

A

> 3wks

Cord lesions

194
Q

When is Epiglotittis/Supreglottitis suspected?

? presentation indicates impending airway comprimise

A

Rapid onset sore throat/odynophagia OOP to exam

Drooling

195
Q

How is Epiglotittis/Supreglottitis Tx

Essentials of Dx for LarygoPharyng Reflux

Dx is made based on PTs response to ?

A

IV Ceftriax and Dexameth
PO steroid taper

Throat irritation
Hoarse
Chronic cough

Response to PPI- Omeprazole

196
Q

What causes Recurrent Respiratory Papillomatosis

This the ? MC in ?

If PT smokes, this can transform into ? Sxs

A

Lesions on larynx where ciliated/squamous epithelia meet due to HPV 6/11

Benign larygneal tumor in kids

Warty lesions on cords

197
Q

? is the mainstay of Tx for laryngeal papillomatosis

How can this condition be prevented

What is the goal of Tx

A

Laser vaporization
Cold knife resections

Gardasil

Voice development
Avoid tracheotomy
Preserve structures

198
Q

Vocal cord nodules and papules are both manifestations of /

Vocal fold nodules are AKA ? in adults or kids

These are common causes of hoarseness due to ?

A

Chronic vocal fold irritation

Singer nodule
Screamer nodule

Vocal cord abuse

199
Q

Define Vocal Cord Polyps

Their prevalence is related to ?

A

Unilateral mass forming on superficial lamina propria on vocal fold

Yelling, Smoking

200
Q

Define Vocal Fold Cyst

How are they Tx

A

Mucus secreting gland cyst on inferior aspect of vocal fold

Laryngoscopy

201
Q

? laryngeal issue is a common cause of hoarseness in smokers

How is this Dx

How is it Tx

A

Laryngeal Leukoplakia

Biopsy

Cessation w/ PPI as mainstay

202
Q

How does SCC of larynx present

This development is related to ? infection

It’s prevalence is strongest in ? PT population

A

Ear/throat pain w/ swallowing
Mass/hemoptysis

HPV 16/18

Non-smokers

203
Q

What is the relation of metastases and SCC in larynx

Vocal cord paralysis can be caused by lesions on ? or ?

A

Uncommon- true vocal cord Ca if cords mobile
Common- supraglottic Ca

Vagus
Unilateral recurrent laryngeal

204
Q

How does vocal cord paralysis d/t neuro dysfunction present

What it the MC and 2nd MC cause of vocal cord paralysis

But first, Ca must be r/o w/ ? images

A

Breathy dysphonia
Effortful voicing

Iatrogenic injury
Idiopathic

Normal CN- CT w/ contrast
Abnormal CN- MRI

205
Q

Unilateral recurrent laryngeal nerve injury causes vocal cords to be stuck in ? position

Bilateral vocal fold paralysis is a rare adverse effect from ?

A

Paramedian- partially lateralized

Total thyroidectomy after reoperations

Normal voice, respiratory compromise
Dyspnea/stridor upon extubation

206
Q

How does vocal cord dysfunction present

How is it Dx

A

Dyspnea/wheezing refractory to bronchodilator Txs

Direct visualization of adduction w/ inspir/exspiration

207
Q

What is the first step in Tx of vocal cord dysfunction

Normal nodes in the neck are smaller than ? size

A

Speech therapy

<1cm

208
Q

What is the Rule of 7s for neck masses

Masses in PTs >40 are usually

A

7 days- inflammatory
7wk-7mon- neoplastic
7 years- congenital

Ca

209
Q

What are the most important parts of H/P for neck masses?

? is the MC neck space infection

Why is this a medical emergency

A

Size Age Duration

Ludwig angina, bilateral infection of submandibular space

Tongue pushed up and back into airway

210
Q

? is the MC cause of deep neck abscesses

Define Lemierre Syndrome

Who does this typically present in

A

Odontogenic infections

Thrombophlebitis of internal jugular vein secondary to oropharyngeal inflammation

ICU PT w/ jugular catheter

211
Q

? microbes are the MC cause of Ludwig Angina

What image is used for Dx

A

Strep
Staph
Bacterioides
Fusobacterium

CT w/ contrast

212
Q

How is Ludwig Tx

How is Lemierre Tx

A

PCN + Metronidazole or,
Clindamycon

Metronidazole

213
Q

? is the MC cause of neck masses across all age groups

What causes this MC

How is it Tx

A

Reactive Cervical adenopathy

Infection of pharynx, salivary gland or scalp

Self resolves over weeks
Clinda/Augmentin

214
Q

? microbe can cause Reactive Cervical Adenopathy

Two primary indications for a tracheotomy

A

Cat scratch fever- Bartonella Henslae

Airway obstruction at/above larynx
Respiratory failure needing prolonged mechanical vent-MCC

215
Q

? is the MC congenital mass of the lateral neck

Where do they present

What are two facts that would r/o this Dx?

A

Brachial cleft cyst, remnant of embryologic development

Anywhere on SCM as painless lump 2-3rd decade

Not midline
Don’t move w/ swallowing

216
Q

How are branchial cleft cysts Dx

How are they Tx

A

CT

Excision

217
Q

? MC congenital mass of the central neck

How does this MC present

A

Thyroglossal duct cyst from embryologic descent of thyroid

<20y/o w/ midline lump below hyoid bone and moves w/ swallowing/tongue protrusion

218
Q

How are Thyroglossal Duct Cysts Dx

How are they Tx

A

TSH, abnormal= scan
CT

Surgical removal via Sistrunk procedure

219
Q

Most of neck tumor metastases is ?

Almost all of these tend to be from ? parts of the body

A

SCC from upper aerodigestive tract

Neck nodes to lung, liver, bone and brain

220
Q

Name of laryngoscope used to depress tongue during neck Ca eval

? specialty uses rigid endoscopes more than any other and why

A

Jako

ENT, biopsy

221
Q

Suspected head/neck Ca needs ? exam prior to refer for ?

R ear AD stand for ?
L ear AS stands for ?
Both ears AU stands for ?
Auricle is Latin for ?

A

HEENT
Triple endoscopy

Auris dextra
Auris sinistra
Auris utraque
Ear

222
Q

How is a lymphoma Dx of the head/neck made

A

FNA can make it

Open biopsy confirms Dx

223
Q

What are the different thyroid Cas

A

Papillary- slow, Dx w/ FNA

Follicuar- aggressive, needle biopsy for Dx

Medullary- poor uptake by thyroid, associated w/ MEN2A
Dx w/ FNA

Anaplastic- least common, most aggressive
Dx w/ FNA

All Tx w/ surgery and post-op iodine ablation

224
Q

Flow chart

A

Slide 72

Neck slide deck

225
Q

PTs w/ TM ruptures lasting longer than 4mon and HL are at risk for ? damage

What are the 3 parts of balance control that work w/ vestibular inputs?

A

Incus damage

Cervical musculature
Eye movement/vision
Arm/leg extensor muscles

226
Q

A lack of ? on BPPV exam makes Dx uncertain

If this is present, when/how does it change?

A

Nystagmus

DHM causes nystagmus to a direction
Upon sitting up, paroxysmal nystagmus in opposite direction should occur

227
Q

What antihistamines are used for acute vertigo?

What Benzos can be used

What anti-emetics can be used

What meds are reserved for Tx room/ED only

A

Dimenhydrinate
Diphenhydramine
Meclizine

Clonazepam
Lorazepam
Alprazolam
Diazepam

Metoclopramide
Ondansetron
Prochlorperazine

Metoclopramide
Ondansetron
Prochloperazine
Promethazine
Diphenhydramine

IPAP (212 decks)

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