ent d/o's

Question 0

painful erythema and edema of ear canal skin
purulent exudate
gram neg; pseudomonas, fungi. grows in excessive moisture

Answer 0

external otitis

Question 1

three types of hearing loss?

Answer 1

Conductive - cerumen impaction, treat if hearing loss
middle ear effusion, Eustachian tube dysfunction
Sensory - presbyacusis - loss of high frequency, trauma/noise exposure, environmental
Neural - lesion involving eighth cranial nerve, auditory nuclei, auditory cortex, tumors and the like.

Question 2

how to tx external otitis

Answer 2

avoid excess moisture, polymixin, cortisporin otic qid
if excessive cellulitis of periauricular tissue use flouroquinolones

found pillowcase to be wet, synonymouse with swimmers ear
f/u in 10 days

Question 3

otalgia with uri (often)
erythema and hypomobility of TM
most common bacteria; streptococcus pneumoniae, haemophilus influenza, and streptococcus pyogenes.

Answer 3

acute otitis media

Question 4

how to tx otitis media

Answer 4

amox or erythomycin and sulfonamide for 10 days one or the other
or… cefaclor, amoxicillin-clavulanate (augmentin)

Question 5

what is peripheral vertigo

Answer 5

onset sudden, associated with tinnitus and hearing loss; horizontal nystagmus may be present

Question 6

what is central vertigo

Answer 6

onset is gradual, no associated auditory symptoms

Question 7

vertigo assessment

Answer 7

duration of vertigo, associated symptoms, triggers, stress/fatigue,lights, diet????
physical; heent, nystagmus - usually horizontal away from the disease side. dix hallpike test for bppv. extending head 30 degrees down. work up includes; eng, vng, mri, vemps- vestibular evoked myogenic potentials

Question 8

bpv - benign positional vertigo

Answer 8

recurrent spells, especially with changes in position

tx physical therapy - floating otoconia within a semicircular canal

Question 9

signs of central lesions

Answer 9

verticle nystagmus
cn palsy
motor sensory deprivation
ENG helpful test

Question 10

acoustic neuroma

Answer 10

8th cranial nerve
pressure on pons which creates hydrocephalus
unilateral hearing loss deterioration of speech discrimination
constant disequilibrium vs. vertigo
MRI - observation/ microsurgical evaluation

Question 11

multiple sclerosis

Answer 11

episodic vertigo and chronic imbalance
Unilateral hearing loss
Dx MRI - refer to neurology

Question 12

viral rhinitis

Answer 12

caused by rhinovirus, adenovirus
can lead to otitis media, sinusitis
usually self limiting
treat with otc’s

Question 13

acute sinusitis

Answer 13

impaired mucociliary clearance and obstruction of the osteomeatal complex. typical pathogens: s aurreas, m. cat, s. pneumonia, streptococi, h-influenza
s/s unilateral pain, purulent nasal d/c, teeth hurt, halitosis, hyposmia, uri >10 days, tender forehead, h/a middle head, high lateral wall pain in ethmoid btween eyes orbital pain
.

Question 14

sinusitis tx

Answer 14

coronal ct best, no use for plain films
decongestant up to 240mg day.. sudafedrin rx
amox fist line… or augmentin bid
macrolide 2nd line- ent’s dont like it
refer to ent if fail atbx, tx ten, then tx 14, ct if not any better w/in 3-4 days.

Question 15

sinusitis - complications

Answer 15

orbital cellulitis, osteomylitis, intracranial extention and cavernous sinus thrombosis.
ct for any changes in ocular exam
refer for failures and ct if symptoms longer than 4-12 wks.

Question 16

sinusitis, when to admit

Answer 16

any facial swelling, proptosis, vision changes, mental status changes.

Question 17

allergic rhinitis

Answer 17

exposure to airborne pollens and spores
s/s = hay fever, eye irritations, pruritis, excessive tearing
PE: thickened mucosa in the turbinates
tx: antihistamines, intranasal corticosteroids, antileukotriene meds

Question 18

oral candidas

Answer 18

white patchy overlay erythematous mucosa
common in pt’s w/ dentures, immonsuppressed, dm, poor hygiene, anemia, chemo, atbx, steroids.
tx: nystatin s/s 5ml qid x 14days or mycelex troches lozenger 5 times a day.. diflucan for systemic - po qd.

Question 19

pharyngitis/tonsillitis - strep throat

Answer 19

Centor criteria: fever, tender anterior cervical adenopathy, lack of cough, and pharyngotonsillar exudate.
group A beta strep -GABS common agent., other causes; N.Gonorrhoeae, mycoplasma, chlamydia.
s/s = lymphadenopathy and shaggy white-purple tonsillar exudate suggests mono, 1/3 have strep. test monospot, cbc for elev. lymphocyte count. avoide ampicillin in these pt.s

Question 20

treat strep

Answer 20

penvk 250mg po tid, or 500mg bid x 10 days
zithromax 500mg po qd x 3 days.
atbx tx usually avoids the streptococcol complications of scarlet fever, glomerulonephritis, rheumatic myocarditis, and local abcess formation.
salt water gargle, benzocaine lozenges
rheumatic fever pt’s tx with prophylaxis for 5 years

Question 21

peritonsillar abscess

Answer 21

severe sore throat, odynophagia, trismus, medial deviation of the soft palate and peritonsillar fold and abnormal muffles voice (hot potatoe).
abcess is unilateral
treat with atbx and i&d
needs referral to ent

Question 22

sialadenitis

Answer 22

caratid gland infection - bacterial affects parotid or submandibular gland
acute swelling, increased pain, swelling with meals -pus can be massaged from duct. most common is staph aureus.
tx: iv nafcillin or augmentin, clindamycin if allergy to aug.
hydration warm compresser, lemondrops, fireball.
can use atbx for ten days
check amylase level - typically elevated.