ENT Disorders Flashcards
A patient with a recurrent history of ear infections presents with ear pain and drainage. Upon examination, you find a ruptured tympanic membrane with a cheesy white substance inside. What is the most likely diagnosis?
Cholesteatoma
You diagnose a patient with a sensorineural hearing loss related to aging. What is the most appropriate way to describe this in the chart?
Presbycusis
A patient was involved in a side-impact motor vehicle collision two days ago. He presents today with swelling to the superior half of his left ear. Exam is otherwise unremarkable. What is the most likely diagnosis?
Auricular hematoma (hematoma of external ear)
What is the immediate treatment for auricular hematoma?
Incision and drainage
A patient presents with a feeling of “fullness” in her ear that she cannot seem to clear. On examination, you note that the TM seems to have been sucked down around clearly visible inner ear structures. There is a saran wrap type appearance to the TM. What is the most likely cause of the patient’s symptoms?
Eustachian tube dysfunction
Before the previous patient could be treated, she developed a sinus infection. She presented this time with ear pain. On examination, you note that inner ear structures are no longer visible, and there appears to be fluid accumulated beneath the TM. What is the most likely diagnosis?
Acute Serous Otitis Media
A patient presents with recurrent episodes of dizziness that seem to occur upon getting out of bed most mornings. The episodes last 15-30 seconds, and there is no associated tinnitus or hearing loss. Ear examination is normal, as is the audiogram. What is the most likely diagnosis?
Benign Paroxysmal Positional Vertigo
You are treating a patient with hearing loss related to repeated exposure to loud noises. He also complains of “ringing in the ears”. How would you describe this symptom in a verbal report?
Tinnitus
You diagnosed a 3 year old patient with acute otitis media last week and prescribed an antibiotic. Her caregiver did not have it filled, however. The child presents today with a high fever and lethargy. The left ear is turned forward. What is the most likely diagnosis?
Acute Mastoiditis
A patient presents with vertiginous symptoms associated with unilateral headache, photophobia, nausea, and vomiting. She describes a history of severe motion sickness, but no hearing loss. What is the most likely diagnosis?
Migrainous vertigo
A patient suffered an acute attack of vertigo that lasted several days. Even after the vertigo resolved, the patient’s balance has been abnormal and he suffers from high-frequency hearing loss. What is the most likely diagnosis?
Labyrinthitis
A patient presents with hearing loss. Upon examination, you are unable to visualize the TM because of earwax accumulation. What is the most likely diagnosis?
Cerumen Impaction
Under which circumstances is removal of cerumen indicated?
The patient is symptomatic
The cerumen interferes with examination
A toddler presents with unilateral ear pain and drainage. Upon examination, you find a plastic bead lodged in the ear canal. It looks as if removal will be difficult, and the toddler is not cooperative. What is the best course of action?
Refer to ENT for removal, probably under sedation.
This structure’s more horizontal orientation in children relative to adults helps to explain the higher incidence of otitis media in the pediatric population.
Eustachian tube
A 5 year-old patient presents with fussiness and fever. Her parents report that she has been tugging on her left ear. On examination, you find a bulging, reddened TM with increased vascularity. The light reflex is absent and no internal structures are visible. What is the most likely diagnosis?
Acute otitis media
The previous patient’s parents report that this is his fifth ear infection this year. What ENT procedure might you recommend?
Placement of pressure equalization tubes
A patient presents with recurrent attacks of vertigo, often lasting for hours at a time, as well as aural fullness and roaring tinnitus. The audiogram shows a low-frequency hearing loss. What is the most likely diagnosis?
Meniere’s Disease
A patient presents with severe ear pain. On examination, you find what appears to be a blister over the tympanic membrane. What is the most likely diagnosis?
Bullous myringitis
You have diagnosed a patient with Meniere’s Disease. Name three initial interventions that you might recommend.
Sodium restriction
Diuretics
Steroids
A 10 year-old child presents with ear pain and discharge. He recently returned home from summer camp where he swam in a lake daily. On exam, you find the ear canal to be erythematous and inflamed. What is the most likely diagnosis?
Otitis Externa
A patient presents with ear pain, dizziness, and hearing loss. He recently returned from a SCUBA diving trip. On examination, you find the TM to be bulging outward, but not inflamed or erythematous. What is the most likely diagnosis?
Barotrauma
A patient presents with right ear pain, tinnitus, and dizziness. Upon examination, you note a vesicular rash on, in and around the right ear. The patient reports that the rash is very painful, and you also notice some right facial paralysis. What is the most likely diagnosis?
Ramsay-Hunt syndrome
What is the etiology of Ramsay-Hunt syndrome?
Herpes zoster infection
A patient presents with a gradual unilateral hearing loss, tinnitus, and balance problems that has developed over a period of many years. You order an MRI, looking for what disorder?
Acoustic neuroma
You are treating a patient for chronic serous otitis media that always presents in the left ear. It would be prudent to evaluate this patient for what associated disorder?
Nasopharyngeal carcinoma
Your patient has been using oxymetazoline nasal spray for the past two weeks to treat congestion. You advise him to discontinue use in order to avoid which complication?
Rhinitis medicamentosa
A pediatric patient presents with nosebleed secondary to digital trauma. What part of the nose (anterior/posterior, septal/lateral) do you suspect the bleeding to be coming from, and what term would you use to describe his condition in the chart?
Anterior septal, epistaxis
A pediatric patient presents with a foul-smelling discharge from the left nostril. Your first suspicion is what diagnosis?
Foreign body
A 60 year-old male patient presents with nasal congestion. He denies eye itching or discharge, and has never had seasonal allergies. Oddly, his symptoms seem to be associated with meals and sex. What is the most likely diagnosis?
Vasomotor rhinitis
A patient presents with itchy, watering eyes, nasal congestion, and rhinorrhea. He denies fever. The patient tells you that he has similar symptoms every year around the same time. What is the most likely diagnosis?
Allergic rhinitis
You are examining a patient with a history of cystic fibrosis who presents with recurrent sinus infections, nasal obstruction, and anosmia. What abnormality might you inspect for inside the nose?
Nasal polyp
On which anatomical structure are most nasal polyps found?
Middle turbinate
A patient presents with nasal congestion, facial pain, and purulent nasal discharge. She also complains of headache. The symptoms began ten days ago and seem to have gotten worse over the past three days. What is the most likely diagnosis?
Acute bacterial rhinosinusitis
Sinusitis is considered chronic if symptoms persists for more than ______ weeks or if radiographic evidence of sinusitis is apparent after ______ weeks of treatment.
12, 4
Mucus color is a ______ (good/poor) indicator of etiology in sinus infections.
Poor
Most upper respiratory infections are caused by ______ and ______ require antibiotic treatment.
viruses, don’t
Name a risk factor for nasal septum perforation.
Drug use, trauma, Wegener’s granulomatosis
