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RRCCPA Clinical Medicine I > ENT-Hugus > Flashcards

ENT-Hugus Flashcards

1
Q

Conductive hearing loss

  1. Define
  2. General tx:
A

dysfunction of external/middle ear

i.e obstruction, mid-ear effusion, scarring, ossicular disruption, otosclerosis (abn bone formation)

Generally corrected with medical or surgical therapy

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2
Q

Sensorineural hearing loss

  1. define
  2. sx/sxs
  3. tx
A
  1. deterioration of cochlea or vesibulocochlear nerve Causes majority of hearing losses
  2. difficulty distinguishing foreground voices against noisy backgrounds, loss of directionality of sound, perception that people mumble, difficulty when on phone
  3. Generally permanent: depends on etiology
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3
Q

Neural cause of hearing loss

  1. Cause
  2. risk factors
  3. Tx
A
  1. Lesions of cochlear nerve VIII or central pathway
  2. MS, cerebrovasc disease, acoustic neuroma
  3. Etiology dependent
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4
Q

Sensory cause of hearing loss

  1. cause
  2. risk factors
  3. tx
A

damage or deficiency of cochlea, usually loss of hair cells.

  1. Presbycusis (age related) from degeneration of cochlea, noise trauma, otoxicity
  2. hearing aids/implants
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5
Q

Weber test

  1. unilateral conductive hearing loss

vs

  1. unilateral sensorineural hearing loss
A

Midline of head

  1. sound lateralizes (is heard in) the bad ear
  2. sounds lateralizes to good ear
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6
Q

Rinne test

  1. Conductive

vs.

  1. Sensorineural
A

mastoid: infront of ear
1. BC>AC (bone conduction vs air conduction)
2. BC

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7
Q

External ear hematoma

A
  1. blunt trauma, blood accumulates in subperichondrial space and can compromise blood flow to cartilage. Neocartilage deposisted after 7-10 days
  2. Immediate surgical evacuation with pressure dressing
  3. Cauliflower ear (necrosis), infection
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8
Q

What can be used to paralyze insect in ear before removal?

A

2% lidocaine

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9
Q

Tinnitus

  1. Define
  2. theories
  3. etiologies
A
  1. ringing/buzzing sound or whooshing in case of pulsatile tinnitus
  2. Middle ear pressure derangement, vascular d/o, neural firing.
  3. High frequency sensorineural hearing loss, ototoxic meds, infxn, ischemia, acoustic neuroma
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10
Q

Eustachian tube dysfxn (ETD)

  1. Define
  2. Risk factors
A
  1. failure of ET to open properly (more common in kids due to the horizontal placement of tube vs in vertical in adults)
  2. rhinitis, URI, sinusitis, chronic OM, bad anatomy
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11
Q

ETD

  1. sx/sxs
  2. tx
A
  1. fullness, pressure, otalgia(ear pain), tinnitus, mild acute hearing loss. Retracted TM, decreased mobility with insufflation
  2. decongestants(short term) nasal spray, valsalva (long term)
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12
Q

Barotrauma

  1. define
  2. risk factors
  3. sxs/exam findings
A
  1. caused by air/water pressure
  2. flying, diving, explosions
  3. Acute pain usually resolves in hours and mild/moderate hearing loss
    exam: hyperamia (excess blood supplying specific organ), edema, ecchymosis of mid ear mucosa, medial displacement of TM, fluid in mid ear, TM perforation in severe cases. Resolves on its own 2-3 weeks
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13
Q

TM perforation

A
  1. trauma, mid ear infxn
  2. if trauma, 90% heal spontaneously, otherwise surgery. Keep ears dry
  3. Ear infxn (chronic), CT temporal, likely need abx, tx with topical abx if otorrhea (drainage) present. Keep ears dry
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14
Q

*AOM (acute otitis media)

  1. MC age group?
  2. risk factors?
A
  1. most common reason for abx for kids. Boys>girls 6-24 months of age
  2. day care, immune related, exposure to smoke
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15
Q

AOM

  1. define
  2. pathophys
  3. MC pathogens
A
  1. acute infxn of mid ear fluid
  2. pt has URI, inflamm edema of mucosa, eustachian tube obstruction, - midd ear pressure, build up secretions, accumulates in mid ear space- virus/bacteria enters space
  3. Bacterial: strep pneumonia, h. influenza, m. catarrhalis
    viral: RSV, rhinovirus, influenza, adenovirus
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16
Q

AOM

  1. Clinical manifestation
  2. tx
A
  1. fever, irritated, restlessness, HA, ear pain, buldging/erythematous TM, HEARING LOSS, decreased mobility with pneumotoscopy
  2. analgesics/ abx- Amoxicillin (if 2> or TM perf 10 day abx, otherwise 5-7)
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17
Q

Chronic Otitis Media

  1. define/cause
  2. Sx
  3. pathogen
A
  1. chronic drainage from middle ear associated with TM perf. Often preceded by AOM that isnt diagnosed or treated properly
  2. May have hearing loss, not usually painful, common in young kids <2
  3. Psudomonas a., ptoteus, S aureus
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18
Q

Chronic otitis media

  1. exam findings
  2. tx
A
  1. TM perf+purulent discharge
  2. Aural toilet (suction, dry mop, earwick, gentle syringe, to remove moisture and debris) + topical quinolone

Abx for 2 weeks: otoflaxin otic solution or ciprofloxacin otic solution

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19
Q

Serous Otitis Media (SOM)

A
  1. Collection of non infected fluid in mid ear. ETD prolonged period. Resultant negative pressure results in fluid
  2. Hearing loss (conductive), speech/;anguage delay, tinnitus, “fullness” in ears
  3. decongestant, myringotomy for chronic cases
20
Q

Otitis externa

A
  1. “Swimmer’s ear”. Otalgia of ext ear, pruritus, hearing loss. Water expsoure, mechanical trauma
  2. erythema and edema in ear canal with exudate.
    (tugging on ear elicit pain)
  3. Pseudomona a, s epidermidis, s aureus
  4. Cortisporin drops not to be used it TM perf.

or Cipro HC first line

21
Q

What is a common water loving bactera?

A

pseudomonas aeruginosa

22
Q

Cholesteatoma

  1. Define/cause
  2. sx
  3. exam findings
  4. tx
A
  1. fast growing kertainized epithel tissue in mid ear can be chronically infected and erode into bone (can cause perm hearing loss).

Occurs d/t ET dysfunction (retraction pocket)

  1. hearing loss, otorrhea (ear drainage), may be asympto.
  2. whitish behind TM, chronic otorrhea
  3. surgical removal + tympanoplasty
23
Q

Mastoiditis

  1. define/pathogen causing
  2. sx
  3. tx
A
  1. bacterial infxn of mastoid air cells (strep. pneumo, strep. pyogene, S. aureus ). Typically complication of AOM
  2. postauricular tenderness, erythema, swelling, fever, otalgia, may be toxic
  3. CT if unclear, culture, ENT consult, IV abx, surgery
24
Q

Vertigo

In different etiologies and their typical duration

A

“true spinning”- sign of vestibular disease.

Ex and durations:

BPPV (benign prox position vetigo)- seconds

Meniere’s disease- 30 min-12 hr

Labyrinthitis- days-weeks

Acoustic neuroma (nerve tumor)- days-weeks

otoxocity (chemo)- months

MS- months

Psychogenic- years

25
Q

BPPV

  1. Define/duration
  2. dx
  3. tx
A
  1. Common peripheral vertigo

lasts only seconds.

  1. dix-hallpile, torsional nystagmus test
  2. Epley maneuver, meclizine, vestibular therapy
26
Q

Meniere’s diease

  1. Define
  2. sx
  3. dx
  4. tx
A
  1. Episodic vertigo, hearing loss, tinnitus, n/v. Endolympth pressure
  2. Usually unilateral, wax/wane (+/-), N/V
  3. Consider audiogram and MRI r/o others
  4. CATS (caffeine, ETOH, tension, salt), low salt diet, diuretic, +/- surgery
27
Q

Labyrinthitis

  1. define
  2. sx
  3. etiology
  4. tx
A
  1. acute onset of continous and severe vertigo may last days to a week.
  2. May have hearing loss and tinnitus, N/V
  3. often follows URI, otherwise unknown
  4. vestibular suppressants
28
Q

Acoustic Neuroma

  1. Cause
  2. sx
  3. dx/labs
  4. tx
A
  1. Tumor of CN VIII, cause of Sensorineural hearing loss (SNHL).
  2. continous disequilibrium than episodic vertigo, unilateral hearing loss with deterioration of speech discrimination
  3. gadonilium- enhanced MRI
  4. Surgical excision- stereotactic radiation therapy
29
Q

allergic rhinitis

A

hay fever. pollens, dust, grasses.

  1. **pale and boggy nasal mucosa, +/- nasal polyps
  2. nasal corticosteroids, flonase, antihistamines, decongestants.
30
Q

Nasal polyps

  1. define
  2. Triad?
  3. tx
A
  1. pale, edematous, mucosal covered masses, like grapes (in kids indicative of CF)
  2. asthma, NSAID allergy, nasal polyps
  3. topical streoids, surgery
31
Q

Epistaxis

tx?

A

Nose bleed MC Kiesselbach’s plexus (anterior septum)

  1. pressure while leaning fwd 10 min. Vasocontrict nasal spray or silver nitrate cautery. Nasal packing, rhinorocket.

1-2 days. if on blood thinners - 5 days

32
Q

Bacteria that may cause sinusitus?

A

Strep pneumo, H influenza, M catarrhalis, Stap aureus

33
Q

Duration of:

  1. acute rhinosinusitis
  2. Subacute rhino
  3. Chronic rhino
  4. Recurrent acute rhino
A
  1. <4 weeks
  2. 4-12
  3. 12<
  4. 4 or more episodes
34
Q

Oral Candidas (thrush)

  1. define
  2. risk factors
  3. sx
  4. dx
  5. tx
A
  1. creamy white curd like patcches-scrapes off (Candida Albicans)
  2. DM, abx, steroids, anemia, chemo
  3. painful sore tongue/mouth/throat.
  4. wet prep with KOH
  5. Nystatin oral suspension, fluconazole
35
Q

Aphthous Ulcer

  1. Define
  2. Causes
  3. Tx
A
  1. Canker sore. 2-6 mm painful round ulcerations with peripheral rim of eythema and a central yellowish exudate. Uknown pathogens
  2. physical (fever) or mental stress, diet
  3. Heals on its own 1-3 weeks. Sx relief: oragel topical pain relief, topical steroids
36
Q

Oral herpes simplex

  1. define
  2. Risk factors
  3. tx
A
  1. HSV type 1
  2. immunocompromised, trauma, stress
  3. painful papules with vesicles that rupture
  4. antivirals (Acyclovir)
37
Q

Leukoplakia

  1. define
  2. risk factors
  3. tx
A
  1. MC pre malignant lesion of oral caivty. white lesions cannot be removed by rubbing mucosa. Can be on tongue or buccal mucosa
  2. Tobacco/ETOH use, dentures, aids
  3. d/c use of tobacco and ETOH, bx may be needed for peristent lesion and surgical excision.
38
Q

Acute pharyngitis

  1. Viral vs bacterial
  2. dx
  3. tx
A
  1. 90% virus (coryza, lack exudate low grade fever, +/- LAD)

*10% bacterial (MC: group A strep) - complications scarlet/rheumatic fever, Glomerulonephritis (inflamm of kidney)

  1. rapid strep, Centor criteria
  2. OTC analgesics. Abx if bacterial
  3. Penicillin, Amoxicillin for kids, Azithromycin if PNC allergy
39
Q

Describe Centor Criteria

A
40
Q

Mononucleosis

  1. Name of virus
  2. sx
  3. labs to order
A
  1. Epstein-Barr virus
  2. fever, pharyngitis, LAD, malaise, HSM, odynophagia (diff swallowing)
  3. Monospot, CBC, anti-EBV titers
41
Q

Peritonsillar Abscess

  1. define
  2. sx
  3. tx
A
  1. collection of pus b/w capsule of the palatine tonsil and pharyngeal muscles (GABHS and resp anaerobes)
  2. trismus (locked jaw), fever, drooling, muffled voice, odynophagia, hot potato voice
  3. Consult ENT, I&D, po abx/IV abx. +/- tonsillectomy
42
Q

Sialolithiasis

  1. define/MC?
  2. RF
  3. sx
  4. tx
A
  1. stone formation in salivary gland duct. MC wharton’s duct (see image)
  2. dehydration and anticholingergic meds.
  3. postprandial pain and/or swelling
  4. hydration, OTCanalgesia, lemon drops (to salivate), surgery
43
Q

Sialadenitis

  1. define
  2. sx
  3. tx
A
  1. Infxn/inflamm of salivary gland d/t ductal obstruction. Bacterial (S Aureus) viral (Mumps)
  2. pain/swelling with meals, purulent discharge may be massaged from duct, +/- systemic sx (fever)
  3. warm compress, lemon drops, hydration, gland massage. Abx
44
Q

Laryngitis

  1. define
  2. sx
  3. tx
A
  1. usually viral, follows URI
  2. Episodic Aphonia, hoarseness, no pain, dry cough
  3. rest, hydration, humidification, abx not indicated!
45
Q

Epiglottitis

  1. define/pathogen?
  2. sx
  3. tx
A
  1. Bacterial H. Influenzae type B or viral
  2. rapidly developing sore throat. Tripod position, dysphagia, drooling, fever, systemic toxicity, swollen cherry epiglottis
  3. “thumb print” sign on xray
  4. Maintain AIRWAY. Consutl ENT. IV abx
46
Q
A

RRCCPA Clinical Medicine I (49 decks)

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