ENT (Ears, nose, throat) Flashcards
Discuss Weber test for conductive hearing loss
The tuning fork is tapped and placed midline and then against the mastoid. IT will lateralized to the affected ear for conductive hearing loss.
And BoneConduction> AirConduction.
What test is used for sensorial neural loss?
Rinne - tests airconducion vs bone conduction.
Sensorineural hearing loss is AirConduction> BoneConduction
What is the hallmark of Meniere’s syndrome?
Chronic hearing loss, tinnitus, dizzyness/vertigo. Nausea and vomiting often accompany these symptoms
Give examples of conductive hearing loss
Cerumen impaction, Acute otitis externa, otosclerosis
Give examples of sensorineural hearing loss
Presbycusis is the most common.
Followed by Menieres, , acoustic trauma, and acoustic neuroma and drug induced.
This type increases with age and may not be helped with hearing aids.
What is the treatment for MEnieres
Diuretics, , salt restriction.
Hallpike maneuer may show nystagmus
Discuss acoustic neuroma (vestibular schwannoma)
PRedominant in females, unilateral,
Insidious hearing loss with progressive growth.
may develop tinnitus, vertigo, ataxia and brainstem dysfunction.
Diagnosed with CT or MRI
Treatment is surgical
What medications can cause drug induced hearing loss?
streptomycin, karamycin, ethacrynic acid, chloramphenicol - may or maynot be reversible with cessation of the medication.
List the causes of infancy and childhood hearing loss
Congenital: asphyxia, erythroblastosis , maternal rubella.
Acquired: MEasles, mumps, pertussis, meningitis, influenza, labyrinthitis
PAtient presents 2 weeks after treatment of AOM. Mom states he imporved but then begain spiking fevers again, had pain behind the pinna and redness around his affected ear. What is your primary suspicion and how do you treat it?
MAstoiditis is treated with IV antibiotics and if that fails them mastoidectomy is i indicated
What are the primary pathogens of otitis externa?
Pseudomonas, enterobacteria, proteus, and rarely fungal
What is rhinitis medicamentosa?
Caused by the overzealous use of decongestant drops or sprays of Oxymetazoline or phenylephrine
Symptoms: severe congestion and nasal pain, minimal discharge.
Treatment: discontinue the irritant. occasionally can use topical corticosteroids while going through the withdrawl period.
What are the Centor criteria for diagnosising pharyngitis
Fever > 100.4 (38C), tender anterior cervical adneopahty; lack of cough. and pharyngeotonsillar exudates. Presence of 3 out of 4 is highly suggestive of Group a Beta hemolytic strep.
If a patient has 3/4 Centor criteria for GABHS but rapid strep is negative what would be next?
Throat culture to rule out strep.
Treatment for GABHS pharyngitis?
PCN/Erythromycin
Risks of incomplete treatment atre Rheumatic fever, Ludwig’s angina and tonsillar abscess
How does viral pharyngitis differ from bacterial pharyngitis
Viral: insidius onset, corzya, lacks exudate, low grade fever, +/- lymphadenopathy
What is leuoplakia?
painless white area on the tounge, insider the cheek, lower lip or on the floor of the mouth. It cannot be scraped off.
Area needs to be biopsied to rule out cancer <5% found to be malignant.
Seen in smokers, chewing tobacco, AIDS and ETOH abuse
What are the most common causative agents in Epiglottis?
Group A strep, pneumocci, staph, or H flu
Most common in kids, but can occur at any age - increasing prevalence in adults due to H flu vaccination.
What is the clinic picture of Epiglottis?
Onset abrupt high fever difficulty swallowing, sore throat, drooling and in kids 0 sitting in sniffing (forward leaning) position.
Diagnosed by lateral soft tissue xray - classic thumb sign
Treat with controlled intubation, patient should not be left alone until intubated.
Then IV fluids and antibiotics 24-72 hours, and then po anbtioitcs for 10 days
Caveat: Treat all unimmunized closed contacts with rifamipin
Where is the most common area of bleeding in common epistaxis?
Kiesselbach’s plexus. caused by minor truam, dry mucosa or coagulopathy.
Treat with pressure for 15 minutes; then if bleeding site can be identified - anestheize with cocaine / lidocaine and cauterize with silver nitrate.
Identify the area of a posterior epistaxis bleed?
Woodruffs plexus - this is uncommon and significant, requiring emergent evaluation and treatment as it is usually arterial bleed and may compromise airway.
Acute sinusitis is most commonly caused by which 2 pathogens?
Strep pneumo and H flu
Oral herpes is best treated with systemic or topical antivirals?
topical is firstline. Systemic antivirals are only indicated for severe cases.
A white oral lesion that cannot be scraped off should make you think of which diagnosis?
oral leukoplakia
Which is the most commonly affected sinus in acute sinusitis?
MAxillary
PAtient presents with a hot potato or muffled voice. What is the most likely diagnosis>
Peritonsillar abscess
What time frame are we talking about for chronic sinusitis?
> 3 months
List the time of year when each of the following allergens is most prominent: Pollen, grass, mold and ragweed.
Spring: Pollen from trees and flowers
Summer: grasses
Fall: mold and ragweed
how long should pressure be applied in Epistaxis?
15 minutes
A child presenting with an erythematous sandpaper rash should make you think of which diagnosis?
Scarlet Fever
What is Ludwig’s angina?
Cellulitis of the floor of the mouth
Infects the submental, sublingual and submandibular spaces bilaterally
caused by dental infection
could obstruct the airway if left untreated.
A patient presents with dysphagia, odynophagia, trismus and edema of the neck and floor of the mouth. The patient’s dentition is very poor.
What is the most diagnostic test and how would you treat?
CT scan of the neck - looking for Ludwig’s angina
Treat with IV antibiotics and prepare for intubation as it can cause complete airway compromise.
Otosclerosis causes which type of hearing loss - conductive or sensorineural?
Conductive.
Otosclerosis is a progressive familiar condition where the bones of the middle ear ( the ossicles) soften then harden resulting in increased imependence to the passage of sound throught the ear.
What is the eitology of Ramsey -Hunt syndrome and which cranial nerve does it affect?
It is Herpes zoster oticus. IT affects CN 7 - the facial nerve.
Patient presents with acute onset unilateral facial nerve paralysis with vesicular lesions of the ipsilateral ear and intense ear pain. How would you treat the most likely diagnosis?
Ramsey - Hunt Syndrome is treated with oral corticosteroids, antiviral meds and pain medications.
What is the most common type of cancer of the oral mucosa?What are the risk factors for this type of cancer?
Squamous cell - 90%.
Alcohol use and tobacco use.
Oral Leukoplakia is a precursor to…
early/ invasive squamous cell CA in 2-6% -
If the white patch cannot be scraped off of the buccal mucosa - biospy it!!
Patient presents with fever, headache and foul smelling drainage into the mouth. what is most likley causative agent?
Sialadenitis - is an infection of the salivary glands caused by Staph aureus or a stone .
Treat with antibiotics or surgically remove stone.
Diagnosed by clinical history and/or CTscan.
what are the complications of untreated mastoiditis?
Hearing loss, brain abscess and menigitis
What complication of the mumps can affect only males
systemic parotitis can cause infertility in males.
True or False - if a dental abscess spontaneously ruptures, no further treatment is necessary.
False - patient still needs to have antibiotics to eradicate the infection.
Children are more likely to infect the ________ while adults are more likely to infect the ____________.
Children are more likely to infect the dental pulp of a tooth while adults are more likely to form abscesses around the surround tissue of the tooth.
In a patient with sensorineural hearing loss, what will the results of the WEBER test be?
The patient will hear the sound louder in the unaffected ear. (lateralizes to the unaffected ear)
Lost 4 complications of untreated Strep Throat.
Scarlet fever, glomerulonephritis, rheumatic fever, and local abscess
Patient presents with round ulcer in the mouth that is yellow-grey and has a red halo. it is on the buccal mucosa and is painful. What do you recommend for treatment?
Apthous ulcers are commonly treated with salt water gargles/swish and spits and over the counter topical numbing medications -
A patient presents drooling, with stridor and in tripod position. What is the diagnosis and how do you treat?
Epiglottitis is treate with a 3rd generation cephalosporin - ceftriaxone.
White oral lesions that can be scraped off leaving punctate bleeding should make you think of what diagnosis?
Oral candida
What are 3 possible treatments for peritonsilar abscess?
NEedle aspiration, I&D, and tonsillectomy.
What virus causes MUMPS?
Paramyxovirus
how do you treat allergic rhinitis?
Intranasal corticosteriod and antihistamines.
What is the treatment of choice for strep?
PCN, amoxicillian and erythormycin.
A patient presents with unilateral hearing loss and a decreased speech discrimination. She also has had issues with her balance over the past week. What is the most likely diagnosis?
Acoustic Neuroma
A patient presents with acute swelling and pain in the cheek that increases with meals. What is the most liely diagnosis?
Sialadensitis - salivary gland infection - causes by staph aureaus.
When is watchful waiting with a diagnosis with acoustic neuroma apprpriate?
this is a very slow growing tumor. Watching a small tumor in the elderly patient is most appropriate.
What type of hearing loss would be caused by a cerumen impaction?
Conductive.
A 14 yo field hockey player presents with prominent adenopathy, white purple exudates in the throat and a palpable spleen. What is the most likely diagnosis?
Mononucleosis
how do you perform a Rinne hearing test?
Place the tuning fork on the mastoid and then move it next to the ear.
An xray of the skull reveals coalescence (honeycombing) of the mastoid air cells. What is most likely diagnosis?
Mastoiditis
AFter 10 days of worsening sinusitis - what antibiotics should you treat first with ?
Augmentin - Amoxicilian/potassium clavuante.
45 YEAR OLD female complains of the feeling of the gound rolling under her feet at times. What is the most likely diagnosis?
vertigo
A patient with a history of smoking presents with a new onset of hoarseness. This has been present for the past 2 weeks. What is the most likely diagnosis?
Laryngeal squamous cell carcinoma.
A patient presents with an acute onset of continuosu severe vertigo for the past 5 days. He does have a history of uRI 2 weeks ago. What is the most likley diagnosis?
Labrynthitis
What does Kiesselbach’s plexus refer to?
a group of veins in the anterior nose that can bleed alot.
A small grouped vesicles on the vermillion border should make you think of what diagnosis?
Herpes
