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Pulmonology - OMS 2 > ENT Disorders - clinical approach > Flashcards

ENT Disorders - clinical approach Flashcards

1
Q

moononucleosis sx (8)

A
  1. fever
  2. fatigue
  3. sore throat
  4. HA
  5. myalgia
  6. exudate
  7. lymphadenopathy (posterior cervical)
  8. enlarged liver or spleen
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2
Q

If a pt gets a rash after taking ampicillin or amoxicillin for URI, what is the most likely dx?

A

mono

(95% EBV-induced Ab to ampicillin)

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3
Q

infectious mononucleosis tx (2)

A
  1. rest
  2. salt-water gargles

(no Abx, cause = EBV)

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4
Q

Danger of mono for sports

A

splenic trauma

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5
Q

presentation of strep (6)

A
  1. strawberry tongue
  2. petechiae of palate
  3. red pharynx
  4. tonsilar exudate
  5. severe sore throat & fever
  6. tender lymphadenopathy (anterior cervical)
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6
Q

if rapid strep comes back neg. what do you do?

A

culter (if high suspicion)

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7
Q

complications of strep pharyngitis

A
  1. peritonsillar abscess
  2. glomerulonephritis
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8
Q

strep pharyngitis tx (2)

A
  1. penicillin
  2. erythromycin (if allergin to PCN)

(goal of tx: prevent acute rheumatic fever)

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9
Q

scarlet fever: 2 key clues

A
  1. circumoral pallor
  2. sandpaper rash
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10
Q

pharyngitis is always caused by which microbial group?

A

viral
(conjunctivitis, no pus)

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11
Q

onset pharyngitis vs. strep

A

pharyngitis: slow
strep: rapid

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12
Q

laryngitis is most commonly caused by what?

A
  1. viral
  2. chemical
  3. overuse

tx: rest

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13
Q

laryngitis f/u

A

2 weeks if persists –> check for CA

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14
Q
A

ludwig’s angina: celullitis in submandibular space

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15
Q

complication of ludwig’s angina?

A

airway obstruction

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16
Q

sx of ludwig’s angina

A
  1. brawny, painful edema of submandibular area]
  2. trismus
  3. fever
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17
Q

tx of ludgwig’s angina (4)

A
  1. ENT and dental consult
  2. airway management: intubate or trac
  3. surgical drainage
  4. broad spectrum abx (PCN + metronidazole, ampicillin/sulbactam, clindamycin)
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18
Q
A

ANUG (acute necrotizing ulcerative gingivitis) aka “Trench Mouth”

(rapid progression of gingivitis)

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19
Q

microbe responsible for trench mouth (2)

A

fusobacterium (anaerob) or spriochete (treponema denticola)

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20
Q

Tx: trench mouth

A
  1. abx: metronidazole, PCN, clindamycin
  2. peroxide rinse
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21
Q
A

peritonsillar abscess: cellulitis behind tonsilar capsule that extends onto soft palate

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22
Q

MC deep facial infection in adults?

A

peritonsillar abscess

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23
Q

sx (4)

A
  1. dysphonia “hot potato” voice
  2. trismus (can’t open mouth)
  3. peritonsillar mass that displaces soft palate
  4. drooling

(prior throat infection, presents unilaterally)

fever & dehydration also

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24
Q

tx: peritonsillar abscess (3)

A
  1. I & D
  2. needle aspiration
  3. abx

extreme caution of internal carotid a.

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25
Q
A

Diphtheria: tenacious gray membrane covers pharynx & tonsils

(tenacious: can’t scrap easily)

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26
Q

diphtheria sx (5)

A
  1. tenacious gray membrane
  2. drooling
  3. nasal discharge
  4. hoarsness
  5. malaise
  6. fever
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27
Q

complications of exotoxin from diphtheria (5)?

A
  1. heart
  2. nerves
  3. liver
  4. kidney
  5. respiratory failure
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28
Q

Diphtheria neuropathy (2)

A

early bulbar weakness, followed by weakness of the trunk, then extremities
(Guillan-barre is opposite)

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29
Q

Diphtheria tx (3)

A
  1. airway management
  2. diphtheria antitoxin
  3. abx: PCN/Emycin
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30
Q

tx: auricular hematomas

A
  1. stop bleeding
  2. expel hematoma (prevents deformity)

(tx w/in 7 days)

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31
Q

2 signs of otitis media w/effusion

A
  1. TM is dull w/no erythema
  2. decreased hearing

(do not give abx prophylaxis)

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32
Q

causes (3)?

A
  1. trauma (slap)
  2. infection
  3. pressure changes

heals sponatneously

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33
Q

sx (2)

A
  1. decreased hearing
  2. drainage

(pain?)

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34
Q

tx (3)

A
  1. penetrating traumas = surgery
  2. keep dry
  3. topical + systemic abx (avoid aminoglycosides)

(no ear drops!)

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35
Q

complication of this condition

A

bone destruction (cholesteatoma)

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36
Q

Define cholesteatoma

A

congenital or acquired overgrowth of keratin producing squamous epithelium in middle ear and/or mastoid

37
Q

Cholesteatoma sx (2)

A
  1. fould-smelling drainage
  2. bone destruction (secretes bone-absorbing substances)
38
Q

tx (2)

A
  1. abx
  2. surgery
39
Q

cerumen impaction: tx (3)

A
  1. ear drops
  2. hydrogen peroxide (1:1 w/water)
  3. irrigation
40
Q

progression of this condition

A

dermatitis -> cellulitis –> chondritis –> osteomyelitis

otitis externa

41
Q

predisposing factors (4)

A
  1. excessive cleaning/scratching
  2. swimming
  3. occlusive devices (headphones)
  4. eczema

(otitis externa)

42
Q

findings on physical exam

(otitis externa)

A
  1. edema
  2. erythema
  3. thick otorrhea
  4. significant pain w/manipulation (ear tugging)
43
Q

tx

A
  1. ear cleaning
  2. topical abx (fluoroquinolones)
  3. steroids

(use systemic abx only if immunocompromised or DM)

44
Q

malignant otitis externa (infection of skull base) is usually seen in which patients (2)?

A
  1. DM
  2. immune compromised

(pseudomonas)

45
Q

epiglottitis MC caused by

A

h. influenzae

46
Q

epiglottitis presentation: kids

(becoming more prevalent in adults due to anti-vaxxers)

A
  1. toxic appearing
  2. pain w/thyroid cartilage movment
  3. drooling, dysphagia, distress
47
Q

dx: epiglottitis

A
  1. severe sore throat w/ neg oropharynx exam
  2. right image: “thumb sign” on xray
48
Q

epiglottitis tx

A
  1. ENT consult, anesthesia, OR for safe intubation, not surgery
  2. abx: ceftriaxone
  3. steroids

(do NOT upset child)

49
Q

candidiasis/moniliasis dx

A

white, curd-like plaques of C. albicans on erythematous base easily scraped off

(leukoplakia does NOT easily scrape off)

50
Q

risk factors: candidiasis/moniliasis

A
  1. age: young or old
  2. abx
  3. dentures
  4. steroids
  5. HIV
  6. chemo
51
Q

Leukoplakia is common in which population?

A

male smokers

(precancer: must bx)

52
Q

red macules w/ulcerations aka

A

ophthous ulcer (canker sore)

(tx: control pain)

53
Q

MC cause of tooth pain

A

periapical abscess

54
Q

MC tooth loss

A

periodontal abscess

55
Q

tx: dental abscess (2)

A
  1. I & D (incise & drain)
  2. augmentin, clindamycin, or metronidazole

(if <2cm –> needle aspiration)

56
Q
A

alveolar osteitis (aka dry socket): severe pain due to localized osteomyelitis

occurs 2-5 days post-extraction

57
Q

Alveolar osteitis tx

A
  1. pack w/iodoform gauze + eugenol
  2. irrigate
  3. abx
  4. pain meds
58
Q

how do you determine prognosis of saving an avulsed tooth?

A

every minute an avulsed tooth is out of the socket, lose a percent of survival
(50 min out of socket = 50% chance of saving tooth)

59
Q

describe tooth fracture types

A
60
Q

causes of facial nerve palsy

A
  1. bells palsy
  2. lyme diz
  3. herpes zoster (ramsey hunt)
61
Q

cause of herpes zoster oticus (ramsay hunt syndrome)

A

geniculate ganglion

62
Q

manifestations of herpes zoster oticus (6)

A
  1. vesicles in the ear canal, tongue or hard palate
  2. severe otalgia
  3. tinnitis
  4. vertigo
  5. hearing loss
  6. bells palsy

(tx: acyclovir)

63
Q

herpes zoster ophthalmicus is caused by invovlement of the ______ nerve.

A

trigeminal
(ophthalmic division)

64
Q

herpes zoster ophthalmicus sx (6)

A
  1. eye pain/redness
  2. vesicular rash
  3. keratitis
  4. iritis
  5. glaucoma
  6. tip, side and root of nose
65
Q

herpes zoster ophthalmicus involves which dermatome?

A

nasociliary
(tip, side and root of nose=”hutchinson’s sign”)

66
Q

herpes zoster ophthalmicus tx (3)

(dx: woods lamp/fluoroscein stain visualizes dendrites)

A
  1. antiviral
  2. steroids
  3. ENT/ophtho referral
67
Q

malignant otitis externa sx

A
  1. drainage from ear
  2. severe ear pain
68
Q

malignant otitis externa: dx

A

osseous erosion on CT & radionuclide scanning

69
Q

tx (2)

malignant otitis externa
A
  1. IV abx: flouroquinolones
  2. surgical debridement (if meds fail)
70
Q

acute bacterial sinusitis (5)

A
  1. purulent nasal discharge
  2. HA
  3. facial pain (toothache-like)
  4. swelling/erythema of sinuses
  5. fever

sinusitis=rhinosinusitis

71
Q

dx: acute sinusitis

A
  1. pain over area
  2. postnasal drainage

(clinical)

72
Q

acute sinusitis complications (5)

A
  1. brain abscess
  2. meningitis
  3. cavernous sinus thrombosis
  4. skull osteomyelitis (pott’s puffy tumor)
  5. orbital cellulitis
73
Q

acute sinusistis treatment
(uncomplicated, mild pain)

A

decongestants (pills & spray)

(abx after 7-10 days w/o improvement)

74
Q

acute sinusistis treatment
(severe pain + discolored discharge)

A

abx

75
Q

patients at risk for posterior epistaxis (3)

A
  1. elderly
  2. HTN
  3. anticoagulants
76
Q

epistaxis tx (3)

A
  1. afrin
  2. compression
  3. packing
    (posterior bleeds = pack, then admit)
77
Q

6 complications of posterior packing (epistaxis)

A
  1. infection (toxic shock)
  2. septal necrosis
  3. cardiac ischemia, arrhythmia
  4. syncope
  5. sinusitis
  6. otitis media
78
Q

4 risk factors for severe hypoxia and CO2 retension after tx (epistaxis)

A
  1. posterior packing
  2. elderly patients
  3. COPD
  4. CHF
79
Q

which complication of nasal fx can lead to deformity, abscess or septal perforation?

A

septal hematoma

80
Q

septal hematoma can lead to what?

A

saddle nose deformity

81
Q

What are the LeForte classifications?

A

type I: horizontal maxilla
type II: maxilla, nose cheeks
type III: craniofacial distraction

82
Q

concerns for type I & II LeFort fx

A
  1. CSF rhinorrhea
  2. airway compromise
83
Q

Le Fort fx tx

A
  1. ENT consult
  2. secure airway
  3. analgesia

(do NOT use nasotracheal intubation!!!)

84
Q

Sialoadentitis typically affects which population?

A
  1. dehydration
  2. chronic illness (DM)
85
Q

How do you differentiate sialoadenitis from mumps?

A

mumps = bilateral

86
Q

sx: sialoadenitis (3)

A
  1. gland is firm
  2. erythema/edema on skin over salivary gland
  3. worse with eating

(can massage pus from duct)

87
Q

Sialoadenitis is usually due to what?

A
  1. obstructing stone
  2. hyposecretion

(calcifications may be seen on xray)

88
Q

Which gland is MC affected by sialoadenitis?

A

submandibular

89
Q

sialoadenitis: tx (5)

A
  1. abx (oral or IV)
  2. hydration
  3. warm compress
  4. lemon drop
  5. surgery

Pulmonology - OMS 2 (28 decks)

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