ENT Phase 2 Rosh

Question 1

Presentation of Oral Leukoplakia

How is it Dx

How is it Tx

Answer 1

50-70y/o male w/ Hx of smokeless tobacco use, presenting w/ painless white hyperkeratosis that can’t be removed on DORSAL tongue

Dx: Biopsy

Tx: Surgery Cryotherapy Ablation

Question 2

What PT population is Oral Hairy Leukoplakia found in?

What is the difference between bacterial and viral etiologies of parotitis

What is the MC bacterial cause

Answer 2

Non-precancerous growths in PTs w/ Hx of EBV and +HIV on LATERAL tongue

Viral= no suppuration

Staph A

Question 3

What lab work results will indicate parotid gland involvement

Best initial imaging

Tx

Answer 3

Inc serum amylase w/out pancreatitis

US
CT to differentiate cellulitis/abscess

Hydrate
IV Nafcillin + Metron/Clinda or Ampicillin/Sulbactam
No relief x48hrs= InD

Question 4

What types of nystagmus/caloric testing results would be seen in PTs w/ labyrinthitis

What ABX consumption can cause similar Sxs

Answer 4

Spontaneous nystagmus to unaffected side
Absent caloric test to affected side

Aminoglycosides- Gentamicin
Macrolides: Erythromycin

Question 5

What medication is used as first line Tx for PO Candidiasis and why is this

If KOH prep is done for Dx, what will be seen?

Answer 5

Nystatin mouth rinses- poor GI absorption, won’t raise liver enzymes

Budding yeast/hyphae

Question 6

What other meds are used for PO Thrush Tx other than PO Nystatin

? is a signal for impending airway compromise in PTs w/ epiglottitis

What ABX are used after admission

Answer 6

Fluconazole- esophageal involvement/+HIV
Ketoconazole
Itraconazole- cases resistant to Fluconazole

Drooling, intubate ASAP

3rd Gen Cephalosporin: Ceftriaxone
Dexamethasone/Budesonide

Question 7

HIB has fallen away as the leading cause of epiglottitis, what other microbes can cause it?

What medication should be given to PTs who have had close contact to HIB?

Answer 7

Strep/Staph
Moraxella

Rifampin

Question 8

? microbe is the MCC of peritonsilar abscesses

How are these Tx

Answer 8

Beta-hemolytic strep

Needle aspiration
Amoxicillin/Clindamycin
InD/tonsilectomy

Question 9

? is the MCC of TM perfs

What Dx is considered for ASx Peds presenting w/ TM perfs?

Answer 9

Infections

Abuse

Question 10

? med is used for acute cases of vestibular neuritis to reduce inflammation and improve vestibular functions

What med is used if the above is ineffective

Answer 10

Prednisone

Valacyclovir

Question 11

? microbe is the MCC of bullous myringitis in Peds

? is the mainstay of Tx

When is an ENT referral needed

Answer 11

Strep Pneumo
H influenzae

Pain control w/ acetaminophen/benzocaine
ABX

Suppurative complication
Mastoiditis
TM perf

Question 12

BPPV is MC from ? located in the ?

Angular cheilitis is AKA ?

Answer 12

Otoconia
Posterior canal

Perleche

Question 13

MCC of Ludwigs is ? microbe

How is it Tx

Answer 13

Strep viridians
ImmComp= Staph A

PCN + Metronidazole
PCN allergy- Clindamycin

Question 14

? is the MC deep neck infection of kids and adolescents

What is done to differentiate peritonsillar abscess from cellulitis?

What form of imaging could be used

Answer 14

Peritonsillar abscess

ABX trial, no improvement= abscess
Ampicillin-Sulbactam
Clindamycin

Intraoral/Submandibular US

Question 15

ABX Tx for intermittent AOM

AB Tx for persistent/recurrent AOM

Answer 15

First: Amoxicillin
PCN-A mild/mod: Cefdinir
PCN-A sev: Clinda + Bactrim

First: Augmentin
PCN-A mild/mod: Clinda + Cefixime/Cefdinir
PCN-A sev: Clinda + Bactrim

Question 16

How is GABHS Tx

? is the TxOC for pharyngitis

Answer 16

Peds: Amox
Adults: PCN
Allergy to Beta-Lactam: Azith/Clindamycin

Viral: Ibuprofen
Bacterial: PCN

Question 17

? types of adenopathy are seen by sore throat etiologies

Two precursors to SCC of mouth

Answer 17

EBV: posterior
GABHS: anterior

Hyperplasia- thick/keratinization of tissue from irritant exposure= white plaques, leukoplakia
Dysplasia= continued hyperplasia, precursor to Ca

Erythroplakia- red plaques from dysplasia (overt malignancy)

Question 18

? HPV form is related to SCC of PO cavity

How do retropharyngeal abscesses present

Answer 18

HPV 16

2-5y/o w/ GABHS/Staph A infection
Fever Respiratory distress
Neck hyperextesnion

Clindamycin
Amp-Sulbactam
Piper-Tazo

Question 19

? is the MC microbe involved w/ dental carries?

Hep C induced oral manifestations?

Answer 19

Strep mutans (?)

Lichen planus: 
Rash
Polygonal, violaceous rash on arm/trunk
Reticular- ASx
Tx: topical CCS (1st)
Topical calcineurin inhibitors (2nd)

Question 20

? is the criterion for Dx GAS tonsillitis?

? causes PO hairy leukoplakia and how is it Tx

Answer 20

Throat culture

EBV in HIV/ImmComp
Antiretrovirals
V/Acyclovir

Question 21

Define PO lichen planus

Who is more likely to have this Dx

How is it Tx

Answer 21

AutoImm response causing painful lacy lesions called Wickham striae

Hep C

CCS
Cyclosporines
Retinoids
Tacrolimus

Question 22

? is MC presenting complaint in Peds w/ AOM?

? is the most specific PE finding hinting towards this Dx

? is the first line ABX for Tx if child has received beta-lactam ABX <30 days ago?

Answer 22

Otalgia

Bulging TM

Amox/Augmentin

Question 23

What PTs are most likely to be affected by BPPV

? type of lifestyle can decrease Peds chance of getting AOM

Answer 23

Female
PTs >60

Breastfeeding

Question 24

How is AOM Dx

What is the criterion standard?

How is SOM Dx

Answer 24

Pneumatic otoscopy

Tympanocentesis w/ culture (ImmComp, persistent)

Tympanometry