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ÅJJB 5th year > ENT minimums > Flashcards

ENT minimums Flashcards

1
Q

How to diagnose vertigo caused by vestibular disorders

A

Patient history:

  • Type of vertigo (sensation of spinning or falling);
  • Vegetative symptoms, nausea, vomiting.

Examination:

  • deviation, tilting;
  • spontaneous nystagmus and nystagmus provoked by head movements.
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2
Q

Causes of dyspnea in the upper respiratory tract

A
  • Upper respiratory tract infections (tonsillitis, epiglottitis, laryngitis);
  • Lumps in the upper respiratory tract: abscess, granulation tissue, malignancies;
  • Non-specific reactions of the upper respiratory mucosa: allergy, Reinke edema,
    hereditary angioneurotic edema;
  • Foreign body;
  • Stenosis;
  • Recurrent laryngeal nerve palsy.
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3
Q

Primary management of epistaxis/nosebleeding (at home/ambulance/by GP)

A
  • The patient should lean forward with open mouth, firm digital pressure should be applied to both nasal alae for 10 minutes;
  • Ephedrine/nasal drop/vasocontrictor solution-imbibed cotton or spongostan should be applied in nasal cavity;
  • Cold compress should be applied to the nape of the neck and to the nasal dorsum;
  • Blood pressure-measurement, antihypertensive treatment if needed.
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4
Q

Clinical features, symptoms and complications of para- and retropharyngeal
abscesses

A

Symptoms:
- throat and neck pain, foreign-body sensation, fever, difficulty in swallowing,
trismus, torticollis, swelling of the lateral or posterior pharyngeal wall, thick
speech, laryngeal/oropharyngeal edema;

Complications:
- oropharyngeal and laryngeal edema, septicemia, mediastinitis, choking.

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5
Q

Most frequent causes of dysphagia

A

GERD;
- Globus feeling, psyhogenic disorders;
- Inflammation in the mesopharyngeal, hypopharyngeal and laryngeal region;
- Tumors in the mesopharyngeal, hypopharyngeal and laryngeal region;
- Neuralgia (n. IX, n. X);
- Sensorial and motor innervation disorders: sensorial disorders in supraglottical
region;
- Foreign bodies in the hypopharynx and oesophagus;
- Esophageal motility disorders, achalasia;
- Diverticulum (e.g. Zenker);
- Esophageal, hypopharyngeal stenoses;

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6
Q

Pathogens of tonsillitis and pharyngitis, indication of antibiotic treatment

A

Pathogens:

Viral (80-90%);

  • adenovirus, rhinovirus;
  • (EBV - infectious mononucleosis);

Bacterial:

  • Streptococcus pyogenes - follicular tonsillitis;
  • Group C and G Streptococci;
  • Mycoplasma, Chlamydia, Neisseria subspecies;
  • (Pneumococci);
  • (Haemophilus influenzae);
  • (Moraxella catarrhalis);
  • (Staphylococcus subspecies);

Antibiotics:
bacterial infection - physical findings, laboratory findings (blood count, CRP, ESR, rapid bacteriological test), acute or chronic infection, presence of immunosuppression.

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7
Q

Clinical features and management of angioedema (Quincke-edema)

A

Symptoms and clinical features:

  • urticaria, edema in the head and neck region;
  • dysphagia, globus feeling or visible swelling in the throat, choking;
  • in a severe form: anaphylaxis;

Treatment: antihistamines, steroids, adrenaline, maintaining free airways: cricothyrotomy/tracheotomy – if needed.

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8
Q

Management and complications of nasal folliculitis and furuncles

A
  • Circumscript folliculitis: local therapy with antibiotic and steroid containing creams, vapor coverage;
  • The patient should be told not to pick or squeeze the lesions;
  • For furunculosis and/or phlegmonous reaction, parenteral antibiotics should be
    administered, along with vapor coverage;
  • The infection is usually caused by Staphylococcus aureus;
  • Possible complications: Facial phlegmone, angular vein thrombophlebitis,
    cavernous sinus thrombosis.
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9
Q

Recognition of hearing loss in childhood

A

Signs of hearing loss in childhood:

  • the newborn does not react to sounds;
  • tone of crying is unusual;
  • babbling period does not appear;
  • visual orientation is dominant;
  • speech development is delayed;
  • tone, pitch, intensity, melody and rhythm of the speech is pathologic;
  • articulation disorders;
  • worse reading and writing skills
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10
Q

What is to be done in case of acute sensorineural hearing loss?

A

In case of acute sensorineural hearing loss, immediate intravenous nootropic/vasodilatating therapy or steroid bolus treatment is necessary with hospitalization; meanwhile detailed investigation is required to be carried out to clarify the etiology. The earlier the treatment is started, the better the outcome is.

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11
Q

Complications of paranasal sinus infections (list)

A

Extracranial complications

  • Periorbital cellulitis;
  • Subperiosteal abscess;
  • Orbital phlegmone / abscess;
  • Osteomyelitis;
  • Sepsis;

Intracranial complications

  • Meningitis;
  • Epi/subdural or brain abscess, encephalitis;
  • Cavernous sinus thrombosis.
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12
Q

Causes of acute hearing loss

A

Conductive type:

  • wax, foreign body;
  • acute tubal occlusion, otitis media (OME/AOM);
  • trauma (e.g. perforation of the tympanic membrane)

Sensorineural type:

  • Noise (acute) induced hearing loss;
  • Viral infection;
  • Vascular causes;
  • Toxical damage (medication, chemicals);
  • Traumas.
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13
Q

Types of rhinitis (list)

A
  • Common infections: Simple acute rhinitis, purulent rhinitis;
  • Specific forms of Rhinitis: TB, syphilis, sarcoidosis;
  • Allergic rhinitis
  • Atrophic rhinitis (oezena)
  • Rhinitis sicca anterior.

Other causes: idiopathic, vasomotoric, hormonal, drug-induced, rhinitis
medicamentosa, occupational (caused by irritants) foodstuffs. (3 causes are required from the “other” group)

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14
Q

Management of choking patients – if intubation cannot be carried out

A
  1. Cricothyrotomy – in the lack of time and appropriate tools: we find the cricothyroid ligament above the cricoid cartilage (using fingers), and after carrying out a transversal incision on the skin, we pierce the ligament with any instrument at hand, and insert a holed tool (e.g. outer tube of a pen).
  2. Tracheotomy – After incising the skin and the platysma, we find (and if necessary - ligate) the isthmus of the thyroid gland, and - at the 2nd or 3rd tracheal cartilage - we make an incision on the anterior wall of trachea (in childhood) or remove a part of the cartilage (in adults). We insert a tube/cannula in order to maintain the free airway.
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15
Q

Swollen neck lymph nodes – causes:

A
  • Non-specific inflammations (e.g. upper respiratory tract infections);
  • Specific inflammations:
    • Bacterial: TB, syphilis, cat scratch disease, tularemia,
    • Protozoal: toxoplasmosis,
    • Viral: HIV-infection,
    • Non-infectious: sarcoidosis;
  • Lymphomas;
  • Metastases of head and neck cancers.
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16
Q

Causes of chronic hoarseness (Why is it necessary to visit an ENT specialist after 3 weeks of hoarseness?)

A
  • Acute and chronic inflammations of the larynx;
  • Benign laryngeal lesions (cysts, granulation, Reinke edema, polyps, papillomatosis);
  • Malignant laryngeal lesions;
  • Recurrent laryngeal nerve paresis, (which can be caused by: hypopharyngeal,
    thyroid gland, esophageal, pulmonary, mediastinal cancer, intracranial diseases);
  • GERD;

It is exceptionally important to diagnose a malignant lesion as soon as we can

17
Q

Causes of ear pain

A

Primary otalgia

  • Otitis;
  • Tumors of the ear;

Referred ear pain

  • Tumors and inflammations of the larynx, pharynx, tonsils, base of the tongue;
  • Dental inflammations, temporomandibular joint syndrome, neuralgic pain.
18
Q

Causes of unilateral otitis media with effusion (OME) in adults and childhood

A

Chronic dysfunction of the Eustachian tube (adenoid vegetation or nasopharyngeal tumor)

In adults, the possibility of a nasopharyngeal tumor must not be left out of consideration!

19
Q

ENT diseases causing headache

A

Viral infection of the upper airways;
- Inflammation of nasal sinuses: (acute and chronic);
- Benign and malignant tumors of nasal sinuses;
- Cervical: cervical vertebra disorders, spondylosis, myalgia;
- Complications of otitis and sinusitis: mastoiditis, meningitis, brain abscess,
inflammation of the petrous pyramid;
- Neuralgias;
- Pain of temporomandibular joint.

20
Q

Clinical features and symptoms of peritonsillar abscess

A
  • Throat pain, referred ear pain;
  • Difficulty in swallowing;
  • Trismus, the speech is thick and indistinct;
  • Oral fetor;
  • Fever, insomnia, loss of appetite;
  • Swelling, redness and protrusion of the tonsil, faucial arch, palate and uvula; the
    uvula is pushed towards the healthy side.
21
Q

Symptoms and clinical features of diffuse otitis externa

A

Symptoms

  • Earache;
  • The external part of the ear canal is painful (especially the tragus);
  • Discharge, itching;
  • Ear congestion, hearing loss;
  • Fever is uncommon.

Clinical findings

  • Swelling and hyperemia of the skin of the ear canal;
  • Serous or purulent discharge;
  • Accumulation of debris in the ear canal;
  • Tympanic membrane appears to be normal.
22
Q

Causes of unilateral nasal obstruction and discharge in childhood and in
adulthood

A

Childhood:

  • foreign body;
  • sinusitis;
  • nasopharyngeal angiofibroma;
  • congenital malformation: choanal atresia, meningoencephalocele.

Adulthood:

  • nasopharyngeal tumors;
  • deviation of the nasal septum;
  • hypertrophy of turbinates;
  • trauma and it’s late consequences;
  • diseases causing nasal cavity obstruction (polyp, benign and malignant tumors);
  • rhinosinusitis.
23
Q

Indications of tonsillectomy (absolute and relative)

A

Absolute indications:

  • rheumatic fever;
  • peritonsillar abscess;
  • tonsillogenic sepsis.

Relative indications:

  • chronic tonsillitis;
  • recurrent tonsillitis;
  • tonsillogenic or posttonsillitis focal symptoms;
  • marked hypertrophy of the tonsils causing mechanical obstruction;
  • if a tonsillar tumor is suspected;
  • obstructive sleep-apnea syndrome or other obstructive sleep-related breathing disorders;
  • severe orofacial / dental disorders causing narrow upper airways.
24
Q

Symptoms of laryngeal and hypopharyngeal cancers

A
  • Hoarseness;
  • Dyspnea;
  • Dysphagia;
  • Referred ear pain;
  • Globus feeling;
  • Hemoptoe;
  • Loss of body weight
  • Neck lump.
25
Q

Causes of peripherial facial palsy (list)

A
  • Bell’s palsy;
  • Herpes zoster oticus;
  • Other viral or bacterial infections (HSV, EBV, Lyme);
  • Acute and chronic middle ear diseases (acute and chronic middle ear infections,
    cholesteatoma, rarely tumors);
  • Tumors of the pontocerebellar angle, vestibular schwannoma;
  • Cranial traumas (pyramid bone fractures), extratemporal traumas;
  • Malignant tumors of parotid gland.
26
Q

Precancerous lesions of the oral cavity and oropharynx

A
  • Erythroplakia,
  • Leukoplakia,
  • Lichen planus
  • Naevus
  • Spongiosus albus mucosae
27
Q

Evaluation of neck lumps – diagnostic steps

A
  1. Correct, accurate registration of patient history: e.g. duration of symptoms, upper respiratory tract infections, dysphagia, hoarseness;
  2. Careful ENT examination – special attention should be paid to the examination of the neck: localization, consistency, sensibility of the lump, its relation to the surrounding structures;
  3. Blood tests: inflammation markers, serology;
  4. Imaging modalities: ultrasound, CT/MRI;
  5. US guided Fine Needle Aspiration Biopsy;
  6. For lymphadenomegaly, excision of the node is carried out only if the evaluation
    of the FNAB reveals lymphoma (or, if it is needed by the pathologist).
28
Q

Complications of acute otitis media (AOM)

A

Extracranial

  1. Intratemporal
    - Acute mastoiditis;
    - Zygomaticitis;
    - Petrositis;
    - Facial nerve palsy;
    - Labyrinthitis;
  2. Extratemporal
    - Abscess: subperiosteal, preauricular, suboccipital, Bezold’s abscess;

Intracranial

  • Extradural abscess;
  • Sinus phlebitis - sinus thrombosis;
  • Subdural abscess;
  • Meningitis, encephalitis;
  • Brain abscess;

General: sepsis.

29
Q

Where does the patient localize the pain in cases of frontal, maxillary, ethmoidal or sphenoidal sinusitis?

A
  • Frontal sinusitis – forehead;
  • Maxillary sinusitis – face;
  • Ethmoidal sinusitis –periorbitally, between the eyes;
  • Sphenoid sinusitis – crown of the head, referring to the occipital area;

All forms of sinusitis can cause diffuse headache.

30
Q

Peritonsillar abscess – treatment

A
  • Drainage of the abscess - puncture, incision, daily opening of the abscess cavity;
  • Tonsillectomy:
    - abscess-tonsillectomy;
    - tonsillectomy 6 weeks after recovery;

Antibiotics, decreasing edema, analgesics, administration of fluids.

31
Q

Clinical features and symptoms of acute mastoiditis

A
  • Associated with, or following acute otitis media;
  • The pinna is pushed forward;
  • Retroauricular pain, erythema;
  • The posterior wall of the external ear canal is swollen, seems to be lowered;
  • Pulsating, severe pain;
  • Pulsating otorrhea.
32
Q

Symptoms and clinical features of acute otitis media (AOM) – suppurative form

A

Symptoms

  • Earache;
  • Hearing loss;
  • Nasal discharge and congestion;
  • Fever, malaise;
  • If perforation is present: otorrhea

Clinical findings
- Ear canal appears to be normal;
- Hyperemia of tympanic membrane;
- Later in the course of the disease: marked bulging of the tympanic membrane,
subsequently spontaneous perforation can develop.

33
Q

Middle-aged, smoker patient presents with unilateral ear pain, but the examination of the ear does not reveal any disorders. What may be the cause, and what is obligatory to be examined?

A

Unilateral, referred ear pain is a typical finding in patients with hypopharyngeal (less commonly supraglottic and oropharyngeal) malignancies. This symptom and the tobacco use in the patient history make the examination of the oral cavity,
oropharynx/hypopharynx, larynx and the neck obligatory.

34
Q

Management of epistaxis/nosebleeding (anterior, posterior) by ENT professionals

A
  • Blood pressure-measurement, antihypertensive treatment - if needed;
  • Visible bleeding source: chemical cauterization (trichloroacetate, silver nitrate) or coagulation (bipolar electrocoagulation);
  • Anterior nasal bleeding: anterior nasal packing;
  • Posterior nose bleeding: posterior nasal packing (Bellocq tamponade), balloon
    catheter.

ÅJJB 5th year (5 decks)

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