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Internal Medicine > ENT > Flashcards

ENT Flashcards

1
Q

Triad of Presbycusis

A

B/L progressive sensorineural deafness With loss of high frequency pitch initially
Need quiet environment to hear
Observation and education as a t/m

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2
Q

How otosclerosis occurs?

A

Due to abnormal bone deposition resulting in stiffening of ossicular chains

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3
Q

How otosclerosis presents?

A

Seen in young adults with conductive hearing loss

Hearing improve in noisy environment (paracusis of willis)

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4
Q

Triad of Aspirin exacerbated Respiratory distress

A

Asthma
Chronic rhinosinusitis with nasal polyposis
Bronchospasm or nasal congestion with following the ingestion of Aspirin or NASIDS

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5
Q

Important point of Aspirin exacerbated Respiratory distress

A

Non IgE mediated diseases

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6
Q

Triad of Perforated Nasal septum

A

Noisy breathing on inspiration
Nasal congestion with crusting and bleeding
Seen in cocaine abuse or nasal surgery

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7
Q

How Vestibular neuritis present?

A

Self limiting condition occur after viral infection
Vertigo that can last days with abnormal thrust test
Sometimes U/L hearing loss

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8
Q

How to manage Vestibular neuritis?

A

Vestibular suppressant like meclizine
Steroids
Vestibular rehabilitation

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9
Q

How BPPV presents?

A

Recurrent vertigo with head movement
Last for less than 1 minute
Dix hallpike maneuver causes nystagmus

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10
Q

Name the complications which leads to Perilymphatic (Labyrinthine) fistula

A

Head trauma
Barotrauma
Ultimately leads to leakage of fluid from semi circular canal

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11
Q

How Perilymphatic (Labyrinthine) fistula presents?

A

Vertigo/. Hearing loss / nystagmus and tinnitus whenever sneezing , straining Or loud noises (Tullio phenomenon)

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12
Q

Name the risk factors which causes otitis externa

A

Water exposure
Trauma like cotton swabs Or Ear candling
Foreign material like headphones or hearing aid
Skin infection like eczema Or contact Dermatitis

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13
Q

Name the organisms causing otitis externa

A

S.auerus

P.aeruginosa

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14
Q

Triad of Otitis externa

A

Ear pain with hearing loss and discharge
Pain with auricle manipulation
Without involvement of tympanic membrane

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15
Q

How to manage Otitis externa?

A

Topical quinolones with or without steroid

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16
Q

Name the risk factors for for leukoplakia

A

Tobacco and alcohol use

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17
Q

How aphthous ulcer present?

A

Localized shallow painful ulcer with a gray base

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18
Q

Name the condition causing Referred Otalgia

A

TMJ joint pathology

Dental caries

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19
Q

Triad of TMJ disorder

A

Referred Otalgia with normal ear
examination

Sign of bruxism (worn and
Jaw pain and TMJ tenderness)

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20
Q

How to managed TMJ disorder

A 
NSAIDs
Dental splint (if bruxism suspected)
Avoidance of triggers , use of soft diet
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21
Q

How eustachian tube dysfunction presents?

A

Ear pain with popping sound
Hearing loss
Tympanic membrane changes

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22
Q

Define Necrotizing (malignant) otitis externa

A

Life threatening infection of the external auditory canal

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23
Q

Risk factors for Necrotizing (malignant) otitis externa

A

Age above 60
Diabetes mellitus
Aural irrigation (cerumen removal)

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24
Q

Name the bacteria causing Necrotizing (malignant) otitis externa

A

P.aeruginosa

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25
Q

Triad of Necrotizing (malignant) otitis externa

A

Severe unremitting pain more at night and with chewing in elderly patient
Granulation tissue at the bony cartilaginous junction and edematous external canal with Purulent Drainage
S’times cranial nerve 7/10/11 affected

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26
Q

How to t/m Necrotizing (malignant) otitis externa?

A

IV cipro with or without surgical debridement

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27
Q

Triad of Ramsay hunt syndrome (herpes zoster oticus)

A

Vesicular rash on the auditory canal or auricle
U/L facial paralysis
Antiviral (valacyclovir) but facial palsy remain

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28
Q

Triad of HSV 1

A

Bell palsy

Vesicular lesions on oral mucosa

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29
Q

Name the most common suppurative complication of AOM

A

Acute mastoiditis

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30
Q

Triad of Acute mastoiditis

A

Fever
Ear pain
Inflamed mastoiditis with displacement of auricle

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31
Q

Examination findings of AOM

A

Bulging tympanic membrane due to inflammation

Decrease TM mobility on pneumatic insufflation on visible air fluid levels indicate middle ear effusion

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32
Q

How to manage acute mastoiditis?

A

IV antibiotics

Drainage of Purulent fluid required via tympanostomy (with or withou ear tube placement) OR mastoidectomy

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33
Q

How to manage Epiglottitis?

A

After securing the airway via ETT, give ABx ceftriaxone and vancomycin

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34
Q

What is the main rain factor for Epiglottitis?

A

Un vaccination

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35
Q

Triad of Epiglottitis

A

Fever with dysphagia and drooling
Lean forward and hyperextend neck to maximaze airway
Stridor and muffled hot potato voice

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36
Q

Why stridor doesn’t occur in bronchiolitis?

A

B/c stridor occurs in upper airway obstruction

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37
Q

Triad of Croup

A

Seen in children age 6months to 3 years
Fever with stridor
Barky cough

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38
Q

At what age foreign body aspiration is Common?

A

Age less than 3 years

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39
Q

Triad of Peritonsillar abscess

A

Seen in older children and adolescent
Gradual onset fever and muffled voice
U/L tonsillar swelling with tonsillar ulceration

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40
Q

Define Otitis media with effusion

A

Middle ear fluid without inflammation

41
Q

Triad of Otitis media with Effusion

A

Seen in children age 6-24 months with episode of AOM or Viral infection
Air fluid levels posterior to the TM and poor TM mobility on pneumatic insufflation
Ear tugging and pulling ear without fever or ear pain

42
Q

How to manage Otitis media with effusion

A

Resolve within weeks and doesn’t require t/m

Chronic OME (>3months) need close follow up and warrant t/m like tympanostomy tube placement as it causes speech delayed and long term hearing loss

43
Q

How to Manage Thyroglossal duct cyst?

A

Confirm the presence of normal thyroid tissue

Do surgical resection of cyst associated tract and central portion of hyoid bone

44
Q

How non TB mycobacterial lymphadenitis present?

A

Slowly enlarging Lateral neck mass

Overlying violaceous skin discoloration

45
Q

Name the ABx for Neonatal sepsis

A

Ampicillin and Gentamicin

46
Q

How laryngomalacia occurs?

A

Chronic stridor due to laryngeal hypotonia, redundant supraglottic soft tissue and inflammation (due to reflux).Floppy supra glottic structures which collapse during inspiration

47
Q

Triad of laryngomalacia

A

chronic inspiratory stridor in infants age 4-8 months
worse in supineposition and improves in prone position
Dx via flexible fiberoptic laryngoscopy which shows ‘‘omega shaped epiglottis and collapse supraglottic structures during inspiration

48
Q

How to manage laryngomalacia?

A

In most cases resolves and just need follow upSupra glottoplasty needs in severe cases like feeding difficulties, FTT, cyanosis or tachypnea

49
Q

How vascular rings present?

A

Biphasic or expiratory stridor due to tracheal compression and feeding difficulties due to esophageal compression

50
Q

Imaging of vascular rings shows

A

bariumswallow can identify indentations of the esophagusdx confirmed via contrast CT Or MR angiography

51
Q

How choanal atresia presents?

A

If U/L –> chronic nasal dischargeIf B/L–>noisy breathing with cyclic cyanosis worsen with oral obstruction like feeding and improves when breath via mouth like during crying

52
Q

How to dx choanal atresia?

A

Initial test is unable to pass the catheter through nares into oropharynxConfirmed test is Ct scan Or nasal Endoscopy

53
Q

How to manage choanal atresia?

A

Oral airwaySurgical airway

54
Q

What is CHARGE SYNDROME?

A 
C COLOBOMA
H HEART DEFECTS
A ATRESIA CHOANAE
R RETARDATION OF GROWTH
G GENITAL ABNORMALITIES
E EARABNORMALITIES
55
Q

Important point

A

Vertical transmission of HPV causes recurrent respiratory papillomatosis which cause hoarseness due to finger shaped nodules on the vocal cordsRequire surgical debridement as mainstay as medicine has limited efficacy

56
Q

What are the risk factors for Acute otitis media?

A

Recent URI
Smoking
Day care center
No breast feeding

57
Q

How to manage acute otitis media?

A

first line is Amoxicillin for infant age less than 6 months and for children more than 6 months with high grade fever, severe pain Or B/L disease

2nd line augmentin for recurrent sxs after 2-3 days of ABx therapy Or Recurrent AOM (within 30 days) after ABx therapy.

If penicillin allergic—> give azomax OR clindamycin

58
Q

Important Point of AOM Tx

A

if penicillinallergy give clindamycin or Azomax as alternate

59
Q

When to consider tympanocentesis in AOM?

A

Tympanocentesis and culture during tympanostomy tube placement when:-Multiple episodes of AOM (>3episodes in 6months)- Or persistent (>3months) middle ear effusion with hearing loss

60
Q

Name the MCC of non-inherited sensorineural deafness in children

A

Congenital CMV infection

61
Q

Important point

A

sensorineural deafness due to noise exposure is rare at age <5 years

62
Q

How is otomycosis present?

A

characteristic appearance of white fungal debri with fruiting bodies or Spores

63
Q

Triad of Chronic suppurative Otitis media

A

Otitis media for more than 6 wks
Otorrhea and hearing loss
Tympanic perforation on examination

64
Q

What are the risk factors for Cholesteatoma?

A

Recurrent AOM
Chronic middle ear effusion
tympanostomytube placement

65
Q

Important Point of Cholesteatoma

A

The dx should be suspected in any patient with continued otorrhea for several weeks despite ABx therapy

66
Q

Triad of Cholesteatoma

A

Otorrhea
Conductivehearing loss.
pearly white mass behind the tympanic membrane or visible retraction pocket with draining debri

67
Q

Triad of Peritonsillar abscess

A

fever with pharyngeal pain and earache
Uveal deviation away from enlarged tonsil
trismus and muffled hot potato voice

68
Q

How to managePeritonsillar abscess?

A

Needle aspiration or incision and drainage

ABx to cover Group A-hemolytic streptococci

69
Q

Important point

A

Recurrent URI would cause AOM not OE

70
Q

What is Landau Kleffner syndrome?

A

An epileptic condition that presents with regression in language milestones after normal development

71
Q

Important Point

A

Frontal sinuses are absent at birth and progressivelypneumatized from age 2 through puberty

72
Q

Important Point of Nasal discharge

A

;If U/L—> think of retained foreign body

if B/L—> allergic rhinosinusitis / adenoidal hypertrophy / acute bacterial sinusitis

73
Q

Name the condition which shows Biphasic stridor

A

Subglottic stenosis

74
Q

Name the condition which shows Expiratory stridor

A

tracheomalacia

75
Q

Important Point of tracheomalacia

A

Inspiration decreases the intra thoracic pressure widens the intrathoracic tracheal airwayExpiration increases the intra thoracic pressure narrow the intrathoracic tracheal airway result expiratory stridor

76
Q

How otomycosis presents and t/m?

A

whitish fungal debris with fruiting bodies or Spores

Topical clotrimazole

77
Q

-Important Point

A

There is perioral numbness in Vertebrobasilar insufficiency(Not Hemifacial)

78
Q

Name the complication due to Retropharyngeal abscess

A

acute necrotizing mediastinitis

79
Q

How does sialadenosis present?

A

Non tender B/L enlargement of salivar gland

Does not fluctuate and not associated with eating

80
Q

Name the risk factors for sialadenosis

A

Alcoholic
Bulimia
malnutrition

81
Q

How salivary stones (sialolithasis) are presented?

A

Tender swelling of salivary gland
fluctuating
painful and increased on eating

82
Q

Why is levothyroxine given in post thyroidectomy due to thyroid cancer?

A

To replace thyroid gland function

also suppresses TSH as tsh will stimulate thyroid tissue resulting in recurrence of cancer.

83
Q

What features in U/S which suggest thyroidcancer?

A

micro-calcifications
irregular margins
increase vascularity
nodule more than 1cm

84
Q

Important Point

A

FNAC is considered as safe procedure during pregnancy

U/S is initial modality of choice for workup of thyroid nodules

85
Q

Name the dx test for CSF Rhinorrhea

A

CSF specific protein (B2 transferrin / B-trace protein)

86
Q

Classified the pediatric neck mass on basis of location

A

if middle–> thyroglossal duct cyst / dermoid cyst
if lateral—> branchial cleft cyst / reactive adenopathy / MAC
If posterior–> cystic hygroma

87
Q

Triad of laryngocele

A

outpouching of the laryngeal mucosa
lateral neck mass enlarges with valsalva maneuver due to air inflation
acquired laryngocele seen in glassblowers / trumpet players due to repeated intense oropharyngeal pressure

88
Q

important point

A

dermoid cyst in neck doesn’t move with protrusion of tongue

89
Q

How d/f types of infections are present on larynx(vocal cords)?

A

fungal –> thick white patches on an erythematous base-

HPV–> irregular exophytic growth in clusters

90
Q

How to d/f nasal septal hematoma and deviated nasal septum?

A

Nasal septal hematoma—> soft fluctuant on examination

DNS—> firm

91
Q

Important Point

A

nasal septal has no direct blood supply and receives nutrients via diffusion.
Destruction of nasal cartilage leads to septal perforations / saddle nose / nasal obstruction

92
Q

How to manage nasal septal hematoma?

A

Incise and drain the nasal septum initially

Do anterior nasal packing with ice packsand NASIDS to reduce edema

93
Q

What is torus palatinus?

A

benignbony growth located at the midline suture of hard palate

94
Q

Name the conditions which would cause Whistling sound (nasal septal perforation)?

A 
Rhinoplasty
nose trauma
syphilis / tb
cocaine nose
sarcoidosis/wegner disease
95
Q

How auricular hematoma present?

A

There is tender fluctuant blood collection in ANTERIOR pinna

96
Q

How to manage auricular hematoma?

A

Immediate incision and drainage

Pressure swelling

97
Q

What are the complications of auricular hematoma?

A

Re collection of hematoma

Bacterial superinfection

Cauliflower ear due to fibrocartilage overgrowth

98
Q

How to treat Barotrauma of the EAR complicated by Rupture of the tympanic membrane?

A

Only Reassurance and follow up Examination

99
Q

Important point of Non scrapped hairy cell leukemia

A

Though occur due to EBV but it is seen in immunodeficient patient such as HIV

So get the test of HIV or underlying cause of immunodeficient before biopsy or any invasive imaging

Internal Medicine (14 decks)

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