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IPAP > ENT Pt 2 > Flashcards

ENT Pt 2 Flashcards

1
Q

Define AD

Define AS

Define AU

A

R ear; Auris Dextra

L ear; Auris Sinistra

Both ears; Auris Utraque

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2
Q

Basal Cell Carcinoma is the MC ?

How does this form of Ca present on PE?

A

MC malignant neoplasm of auricle; from sun exposure

Pedunculated Ulcerated Nodule Translucent Rolled Bleeding

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3
Q

What are the 3 types and one benefit of Dx w/ BCC of the auricle?

How is it Tx both Non/Surgically?

A

Superficial spreading
Ulcerating
Nodular- morpeaform
Rarely metastasizes

Non: Topical 5-FU, Radiation
Surg: Excision, Mohs surgery

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4
Q

What is the precursor to Squamous Cell Carcinoma?

What PT population is this form more likely to be seen in?

A

Actinic Keratosis

Older male PTs

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5
Q

What are the RFs for PTs to develop Squamous Cell Carcinomas on the auricle?

A

Age
Non-healing ulcer

ImmSupp
Chemical
UV radiation

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6
Q

How do Squamous Cell Carcinomas of the auricle present on PE?

Why is this Dx less favorable than BCC?

A

Ulcerated plaque/nodule prone to bleeding

More aggressive, requires larger excision area for Tx

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7
Q

How are auricle SCC cases Tx w/ Non/Surg methods?

How do these Tx options change for cases that are more advanced?

A

Non: radiation
Surg: excision, Mohs

Neck dissection w/ parotidectomy

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8
Q

What is a poor prognosis finding for PTs w/ auricle SCC?

Characteristics of Malignant Melanoma

A

CN7 and lymph node involvement

Unpredictable tumor that affects all ages w/ high mortality rates

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9
Q

How does a Malignant Melanoma of the Auricle present on PE?

What is used to determine the severity and PT survivability?

A

Pigmented lesion that moves from epidermis to dermis w/ ABCDE changes

Depth of invasion

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10
Q

How are Malignant Melanomas of the Auricle Tx

What are the ABCDEs of determining if a lesion is a mole or melanoma?

A

Excision w/ possible lymph node dissection

Asymmetry Border Color Diameter Evolving

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11
Q

How doe Epidermal Inclusion Cysts present in clinic?

When/how are these growths Tx?

A

Well defined borders around soft, mobile and non-tender punctum that can spontaneously drain smely contents

At PTs request w/ Triamcinalone injection 3mg/mL

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12
Q

Where does blood accumulate during the formation of an Auricular Hematoma?

How are they Tx

A

Between cartilage and perichondrium

<24hrs: needle aspiration
>24 hrs but <7d: incision
Pack x 7days w/ 24hr f/u

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13
Q

What ABX are used for Auricular Hematomas

When do these PTs need to be referred?

A

Staph coverage: Dicloxicillin, Cephalexin
Pseudomonas coverage: Ciprofloxacin

Hematoma >7days old

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14
Q

When/where are Local Blocks used for Tx of Auricle Hematomas?

A

Simple lacerations
10mL 1% Lidocaine via 25-27g needle
Posterior: sulcus behind inferior pole of auricle
Anterior: superior and anterior to tragus

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15
Q

When/where are Regional Blocks used for Tx of Auricle Hematomas?

Up to 5mL of anesthetic can be used on each pass but do not exceed how much total?

A

Extensive lacerations, best for avoiding tissue distortion
Inject 5mL 1cm above superior pole of auricle directed anterior to tragus

4mg/kg of 1% Lidocaine

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16
Q

Lacerations to the ear that travel anterior to ear may disrupt or damage what two structures?

If imaging is needed for evaluating these injuries, what type is ordered?

A

CN7
Parotid gland

CT w/out contrast

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17
Q

What Tx method is preferred for ear lacerations?

When does this preference change?

A

Primary closure

Delayed closure if >24hrs or signs of inflammation

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18
Q

When do ear lacerations need to be referred to Plastics, OMFS, ENT or NeuroSurgery?

A

Basilar Skull Tx
Auricular avulsion
Laceration w/ EAC extension
Laceration w/ Middle/Inner injury (HL, Vestibular Sxs)

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19
Q

Define Cellulitis

Define Perichondritis

Define Chondritis

A

Infection of the skin

Infection of the tissue surrounding cartilage

Infection of the cartilage; spares lobule

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20
Q

Peri/Chondritis cases difficult to Tx due to ? and are MC caused by ? microbe

How are they Tx?

A

Lack of blood supply to cartilage
P. aeruginosa

Mild: PO Fluoroquinolone w/ f/u <24hrs
Mod-Sev: IV Fluoroquinolone w/ Aminoglycoside, possible surgical debridement

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21
Q

Characteristics of cerumen

How many impactions need to occur per year for a PT to be Dx w/ recurrent impactions?

A

Hydrophobic substance that creates acidic environment against bacteria/fungus and prevents skin penetration/maceration

> 1/yr

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22
Q

What are the two parts of the EAC

What is the name of the point where the EAC narrows

A

Lateral 1/3: cartilage w/ hair and glands
Medial 2/3: bone w/ skin attached to temporal bone

Isthmus, superior to mastoid process

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23
Q

What are the 4 etiologies of cerumen impactions?

Usually ASx, what Sxs can this condition present w/?

A

EAC Dz induced obstruction
Narrowed EAC
Failed migration
Over production

HL Otalgia Fullness Itching

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24
Q

What is the recommended hygiene frequency for PT w/ cerumen impaction?

What is the indication to remove impaction and what benefit can be expected?

A

External cleaning w/ washcloth max of 1/wk

Only remove if Sxs
PT hearing improves x 10dB

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25
Q

What are the 3 recommended methods in order of preference for removing cerumen impactions?

Do not use the first method for longer than ? days

A

Cerumenolytics
Irrigation
Manual removal

3-5days max use

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26
Q

Cerumenolytics are safe to use in PTs after r/o ? c/is?

When should these meds be avoided?

A

No Hx of Infection Perf or Oto surgery

Suspected TM damage: Otorrhea Otalgia Frequent infxn Hx

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27
Q

What are three types of cerumenolytics that can be sued for impaction Tx?

If irrigation is done, what mixture is used and where is it aimed at in the canal?

A

Mineral oil
3% Hydrogen Peroxide
Carbamide Peroxide 6.5%- 5-10 drops/ear x 15min BID x 4days or less

1:10 water/hydrogen peroxide dilution aimed posterior and up in canal w/out inserting catheter past lateral 1/3 of canal (<8mm)

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28
Q

After irrigating ear canal to remove impactions, what two steps should be done?

When are these f/u steps required?

A

Inspect
Acidification w/ water and 2% Acetic/Boric Acid

ImmComp PTs

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29
Q

Refer cerumen impactions to ENT for manual removal if ?

If PTs have predisposing conditions that put them at risk for recurrent impactions, what at home steps can be done to prevent formation?

A

TM perf
Recurrent impactions
Conservative Tx failure
COM/TM perf Hx

Mineral oil cotton ball x 1-15min 1/wk
Remove hearing aids at night
Provider cleaning q6-12mon

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30
Q

When using water during irrigation cleanings, why must water be at body temp?

Why does drying of the canal w/ air or alcohol after irrigation need to be done?

A

Avoid vestibular caloric response

Prevent development of external otitis

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31
Q

How do FOBs in the ear canal present?

What can happen if chronic/persistent retention occurs?

A

Pain Pruritis CHL Bleeding

Infection
Tissue granulation

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32
Q

What Tx step is not done for organic objects such as food or bugs found in ear canals?

What is done for insects discovered in the canal?

A

Irrigation

2% lidocaine

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33
Q

How does Otitis Externa present in clinic?

What adverse outcome can develop from this condition?

A

Painful erythema, edema and exudate from ear canal skin w/ pain from auricle manipulation

ImmComp can develop Osteomyleitis of skull base (malignant external otitis)

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34
Q

If PTs develop osteomyelitis from external otitis, what microbe is usually the cause?

Where does the infection start and how does it progress inward?

A

Pseudomonas aeruginosa

Floor of ear canal
Middle fossa floor
Clivus
Contralateral skull base

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35
Q

External Otitis is AKA ? and usually due to ? microbe/fungi?

These microbes or fungi are usually the cause of this AKA due to their preference to grow between ? pH?

A

Swimmer’s Ear
Gram Neg rods: Pseudomonas, Staph A
Aspergillus

6.5-7.3

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36
Q

What PE findings during assessing External Otitis indicates PT has an advanced/more severe case?

How are these cases w/out underlying infections Tx?

A

Adenopathy at periauricular/anterior nodes

50/50 isopropyl alcohol/white vinegar
2% Acetic acid

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37
Q

What ABX can be used for the Tx of moderate AOE?

A

Polymyxin B/Hydrocortixone- caution, contains neomycin, potential sensitizer of skin

Aminoglycosides- ototoxic, do not use if TM perf present

Quinolones- Cipro/Ofloxacin

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38
Q

When/why would systemic ABX need to be used for AOE Tx?

What medication is added and used in conjunction w/ systemic ABX?

A 
Cellulitis
DM
ImmDef
Severe Otitis Externa
Edema present preventing application of topical meds

Cipro 500mg BID x 7d

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39
Q

Why does the TM become erythematous during otitis externa infections?

Why is this differentiation important

A

Lateral part of TM is ear canal skin

AOM allows TM to move w/ pneumatic otoscopy

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40
Q

Malignant external otitis can infect and impair ? CNs and signifies ?

How is this diagnosis confirmed?

A

6 7 9 10 11 12
Poor prognosis

Osseous erosion on CT scans

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41
Q

How is Necrotizing Otitis Externa Tx

A

Daily debridment w/ Antipseudomonal drops and systemic ABX

Cipro 200-400mg IV q12h,
Cipro 500mg PO BID until gallium scan proves dec/no inflammation
Refractory= surgical debridement

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42
Q

Define Exostoses

Define Osteoma

A

EAC lesions of broad based bony lesions made from lamellar bone
(AKA Surfer ear from cold water)

Pedunculated EAC lesion of benign neoplasms on tympanosquamous/mastoid line

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43
Q

? is the MC Ca neoplasm of the ear canal?

When is this Dx considered?

A

SCC

Otitis externa doesn’t resolve w/ therapy

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44
Q

Why do SCC in the ear canal have such a high fatality rate?

How are these Tx

A

Tumors tend to invade lymphatics in cranial base

Wide surgical resection and radiation therapy

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45
Q

Define Adenomatous tumors in EAC

What are the MC causes of ET dysfunctions

A

Tumor originating from ceruminous glands, indolent course usually

Viral URI
Allergies

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46
Q

PTs w/ ET dysfunction are at risk for ?

If dysfunction is due to viral illness, what meds may offer relief?

What third med is offered if PTs cause is allergies?

A

Serous otitis media

Pseudoephedrine
Oxymetazoline

Intranasal CCS- Beclomethasone dipropionate

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47
Q

What can cause the development of a Patulous Eustacian Tube

How is this condition’s presentation unique and used for Dx

A

Rapid weight loss

Worse w/ exertion
Better w/ URI

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48
Q

How are patulous ETs Tx

How is dilatory ET dysfunction Tx

A

Avoid decongestants
Ventilation tube insertion to reduce outward stretch
ET surgery

Pseudoephedrine
Oxymetazoline
Beclomethasone dipropionate (allergies)
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49
Q

Why are Peds PTs at higher risk for ET dysfunction

These RFs tend to self resolve by ? age of development

A

Shorter ET
Horizontal ET
Immature cartilage
Large adenoids

6y/o

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50
Q

What can cause Dilatory ET dysfunction to develop

What can cause Patulous ET dysfunction?

A

Inflammation (VURI, Allergy, 3rd Trimester)
Altitude changes
Anatomic/Congenital abnormalities

Weight loss
Scars
Neuro d/o induced atrophy
Hormones- high E during pregnancy, OCP, prostate Ca Tx

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51
Q

How does TM w/ dilatory dysfunction appear on PE

How does TM w/ patulous dysfunction appear on PE?

A

HL w/ retraction/effusion

Autophony
Normal TM w/out HL
TM moves w/ ins/expiration

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52
Q

Serous Otitis Media is AKA ?

What causes these conditions

A

OM w/ Effusion

Prolonged blockage in ET tube causing negative pressure forming transudate fluids

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53
Q

SOM is usually caused by ? three things

When does this Dx become concerning?

A

URI
Barotrauma
Chronic allergic rhinitis

Unilateral and persistent >3mon- nasopharyngeal Ca

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54
Q

How does SOM present on PE

What is the best way to confirm Dx

A

CHL w/ fullness
Dec TM mobility w/ visible bubbles

Tympanometry

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55
Q

How is SOM Tx

A

PO CCS- prednisone
Amoxicillin

No relief after months, ventilation tubes

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56
Q

Define AOM

How does this present in clinic

A

Bacterial infection in temporal bone

Otalgia w/ URI
Erythemic, hypomobile TM

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57
Q

What are the 3 MC microbes causing AOM

What mastoid findings may be seen on PE and what do they mean?

A

Strep Pneumo
H influenza
Strep pyogens

Tenderness, due to pus- non-emergent
Swelling over mastoid bone or CN neuropathies- urgent

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58
Q

What are 4 modifiable RFs for the development of AOM

What are the two non-modifiable RFs

A

Pacifier
Bottles
Day care
Second hand smoke

Allergies
Craniofacial abnormalities

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59
Q

How is AOM Tx w/ ABX

This step is only used if ? criteria are met?

A 
Amoxicillin
Resistant: Cefaclor, Augmentin*
PCN Allergy-
Mild-Mod: Cefdinir, Ceftriaxone
Sev: Erythromycin + Sulfonamide

ABX:
Adult or <2y/o
No improvement x72hrs
Severe Sxs

Observe:
>2y/o
Healthy w/ mild illness (<102.2*)
Able to f/u, start ABX

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60
Q

When/why would a tympanocentesis be conducted for AOM work up?

When is surgical drainage indicated?

A

ImmComp and infection is recurrent w/ proper attempts at medical Tx

Myringotomy- severe otalgia or complications (mastoiditis, meningitis) occur

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61
Q

What is the criteria for recurrent AOM?

Recurrent cases of AOM can be managed w/ ? prophylactic drug?

What is the next step if this Tx method fails?

A

3 or more in 6mon
4 or more in 12mon

PO Sulfamethoxazole
PO Amoxicillin

Insert ventilation tubes

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62
Q

Define SNAP Approach to AOM Tx

A

Safety Net approach to ABX Prescriptions

Give Rx but only fill if failure to improve >72hrs or Sxs worsen

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63
Q

What is the #1 Sx of AOM that frequently goes untreated

What is an expected Amoxicillin reaction seen in kids?

Why is this expectation important to note?

A

Pain

Maculopapular rash on trunk, spreads >72hrs after ABX start

EBV infection= rash
Monospot test

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64
Q

What types of osseous changes may be seen in COM cases?

What are the common microbes seen in these cases?

A

Osteitis- inflammation of bone
Sclerosis- abnormal hardening

Pseudomonas
Proteus
Staph A
Mixed anaerobes

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65
Q

What is the hallmark of COM?

What ABX are used for Tx along w/ water avoidance?

A

Purulent aural discharge, worse during URIs or post-water exposure

Drops:
Ofloxacin 0.3%
Ciprofloxacin w/ Dexameth
PO Cipro- Pseudomonas infxn, helps keep draining ears dry

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66
Q

What is the definitive Tx method for COM?

What step is done if mastoid air cells are infected w/ irreversible infections?

A

Surgical TM repair w/ temporalis muscle fascia

Extended via mastoidectomy

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67
Q

Define Cholesteatoma

How is it Tx

A

COM variant;
MC from ET dysfunction w/ TM moving inward. Sac formed, filled w/ keratin= mastoid penetration, CN8 involvement

Surgical marsupialization- mastoid bowl
PE tubes

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68
Q

What meds are used for TM Perfs w/ purulence?

What types of meds must be avoided?

A

Ofloxacin/Cipro HC

Aminoglycosides
Alcohol
Polymyxin/Neomycins

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69
Q

When do TM perfs need to be referred to ENT for surgical repair?

What are the 3 layers of TM

Why are the layers important?

A

> 25% TM surface
Last >6wks
Persistent HL

Squamous Collagen Cuboidal

Squamous + Cuboidal= chronic perf, Tx w/ tympanoplasty

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70
Q

What is the image of choice for suspected cholesteatomas?

When is the imaging modality also preferred in suspected emergent cases?

A

CT

Mastoiditis
+ finding= emergency ENT

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71
Q

How is mastoiditis Tx w/ ABX

These ABX are directed at ? 3 MC microbes

A

IV Cefazolin
Myringotomy for culture
Tx failure/definitive= mastoidectomy

Strep Pneumo
H Influenza
Strep Pyogenes

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72
Q

How does Petrous Apicitis develop

What syndrome develops

A

Medial petrous bone between inner ear and clivus is obstructed

Gradenigos-
Retro-orbital pain
AOM/foul d/c
Abducens nerve/CN6 palsy

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73
Q

How are cases of Petrous Apicitis Tx

What complication can develop

A

Surgical drainage- petrous apicectomy w/ ABX

Meningitis

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74
Q

What is the difference in presentation and Tx between AOM and COM induced facial paralysis?

A

AOM- CN7 inflammation in middle ear (neurotoxin from bacteria)
Tx: myringotomy w/ IV ABX

COM: pressure of CN7 from cholesteatoma
Tx: surgery; less favorable prognosis

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75
Q

? is MC intracranial complication of ear infections

What is an uncommon complication from ear infections?

A

Otogenic meningitis

Brain abscess

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76
Q

What causes AOM to develop into Otogenic Meningitis

What causes COM to develop into Otogenic Meningitis

A

Hematogenous spread of H influena or Strep Pneumo

Spread through petrosquamous suture or through petrous pyramid dural plates

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77
Q

Brain abscesses from chronic infections are usually located in ? parts of the brain

These abscesses are usually d/t ? microbes?

A

Temporal lobe
Cerebellum

Staph A
Strep Pyogenes/Pneumo

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78
Q

Define Otosclerosis

What is the difference in types of HL in this condition

A

Familial tenency for bony growth on stapes, induces 60dB HL

Lesions on stapes= CHL
Lesion on cochlea= SHL

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79
Q

What medications can be used prior to air descent to help prevent barotrauma?

What is done for Tx of acute middle ear pressure persisting on ground level w/ pain and HL

A

Pseudoephedrine- hrs prior
Oxymetazoline- one hr prior

Myringotomy

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80
Q

Define Perilymphatic Fistula

What may be the only S/Sxs of decompression sickness during the ascent phase of a saturation dive?

A

Diving induced pressure causing round window rupture= SHL and Vertigo

SHL, Vertigo

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81
Q

Why are TM perfs a c/i for diving?

What Sxs can be experienced?

A

Unbalanced thermal stimulus to semicircular canals

Vertigo Disorientation Emesis

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82
Q

Since primary middle ear tumors are rare, what two types may be seen

How to they present to clinic?

A 
Glomus tympanicum (middle ear)
Glomus jugulare (jugular bulb w/ upward erosion into hypotympanum)

Pulsatile tinnitus and CHL

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83
Q

PTs w/ pulsatile tinnitus need ? imaging modality

Large glomus jugulare tumors can impact ? CNs?

A

Magnetic Resonance Angiography/Venography

CN 7 9 10 11 12

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84
Q

? two MC causes of earaches

Sensory innvervation of the ear is derived from ? nerves

A

OE and AOM

Trigeminal
Facial
Glossopharyngeal
Vagal
Upper cervical
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85
Q

What medication can be used to help reduce pain from glossopharyngeal neuralgia

If refractory to this medical management, what Tx step is next?

A

Carbamazepine

Microvascular decompression of CN9

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86
Q

? fluid surrounds the membranous labyrinth?

? fluid is within the membranous labyrinth and why is this type important?

A

Perilymph- similar to CSF

Endolymph- K+ ions for auditory signal generation

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87
Q

What is the difference between vertigo and dizziness?

What are the 4 broad categorical causes of dizziness?

A

All V is D, not all D is V

Vertigo
Pre/Syncope
Disequilibrium
Non-specific light headed (dec blood flow)

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88
Q

Vertigo is Latin for ?

Asymmetry of the vestibular system is due to damage/dysfunction in ? parts of the ear?

A

To turn

Labyrinth
Vestibular nerve/structures

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89
Q

What is the difference between peripheral and central vertigo?

A

Peripheral- studied by otolaryngologists

Central- studied by neurologists

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90
Q

Define Peripheral Vertigo

Define Central Vertigo

A

From dysfunction in labyrinth or vestibular nerve; more severe w/ sudden onset

Dysfunction in brain stem/cerebellum; milder/insidious onset

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91
Q

How can PTs w/ central vertigo present

How can PTs w/ peripheral vertigo present?

A

Slurred speech
Diplopia
Pathologic nystagmus
No auditory Sxs

Tinnitus
HL
Horizontal nystagmus

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92
Q

What is the key to Dx of vertigo

Vertigo work ups include ? evaluations

A

Duration
Associated HL

Audiogram
ENG/VNG
Head MRI

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93
Q

Peripheral causes of vertigo

A 
Vestibular neur/labyrinthitis
Meniere dz
BPPV
ETOH
Barotrauma
Semicircular hehiscence
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94
Q

Central causes of vertigo

A

Seizure
MS
Wernicke encephalopathy
Cerebellar ataxia syndrome

*evidence of brainstem involvement r/o peripheral but lack of brainstem involvement does NOT r/o central lesions

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95
Q

? is the cardinal Sx of vestibular dz

This cardinal Sx needs to be differentiated from ? three DDx

A

Vertigo

Imbalance
Light headed
Syncope

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96
Q

Acute peripheral lesions usually cause ? type of nystagmus to be seen?

What PE test can be conducted

A

Horizontal w/ rotary components and fast phase beating away from side w/ dz

Dix-Hallspike- elicits delayed fatigable nystagmus (peripheral)
Non-fatigable- CNS dz

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97
Q

What device is used during peripheral vestibular dz work ups to prevent visual fixations?

What is the name of the test used to demonstrate vestibular asymmetry?

A

Frenzel goggles

Fukuda test

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98
Q

Define ENG

Define VNG

A

Electronystagmography- electrodes record eye movements from visual/vestibular stimuli

Videonystagmography- camera records eye movement in response to stimuli

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99
Q

? test is sensitive and used to evaluate vestibular d/o?

Meniere’s Syndrome is AKA ? and only has ? two known etiologies

A

Caloric stimulation

Endolymphatic hydrops- trauma, syphilis

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100
Q

Classical Dx of Meniere is made w/ ? criteria

What would be seen on caloric testing in these PTs?

A

Episodic vertigo
SNHL
Tinnitus
Aural fullness

Loss/Impairment on affected side

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101
Q

How is Menieres managed?

What is added for Tx to refractory cases?

A

PO Meclizine/Diazepam
Acetazolamide

Intratympanic steroids
Endolymphatic decompression
Vestibular ablation

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102
Q

PT has vertigo, SNHL and tinnitus but NO hearing fluctuations means ?

Vestibular Neuronitis is AKA ? 3 terms

A

Migraine associated dizziness

Vestibular neuritis- preserved hearing
Labyrinthitis- unilateral SHL
Peripheral vestibulopathy

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103
Q

How do PTs w/ Labyrinthitis present

What will be seen on PE

A

Acute, continuous and severe vertigo <7days
HL w/ tinnitus

Spontaneous horizontal nystagmus, suppressed w/ fixation
+ head thrust test

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104
Q

What meds are used for Tx of labyrinthitis

What causes the Sxs of BPPV

A

ABX (fever/bacterial infxn)
Diazepam/Meclizine

Otoconia/sediment entering semicircular canals, shifts endolymph= stims CN8

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105
Q

? CNS d/o can mimic BPPV?

What imaging is needed for this suspected Dx

A

Vertebrobasilar insufficiency

MRI

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106
Q

How are central lesion PE findings different than those seen on BPPV exam?

How is BPPV Tx?

A

CNS- no latent period, fatigability of habituation of S/Sxs

PT: Epley maneuver, Brandt-Daroff exercises

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107
Q

How does the Epley maneuver help Tx BPPV

Only medication that is pregnancy safe for acute vertigo Tx

A

Encourages debris migration to ant/post canal and exit

Meclizine

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108
Q

What do PTs w/ Vestibular Neuronitis present w/?

What would be seen on PE

A

Vertigo w/out impaired auditory function x days-weeks

+ nystagmus
No caloric response bilateral

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109
Q

How are PTs w/ Vestibular Neuronitis Tx?

? is the MC cause of vertigo after a head injury?

A

Meclizine/Diazepam

Labyrinthine concussion

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110
Q

If PT has a basilar skull Fx after traumatic vertigo, what do they present w/?

What causes chronic post-traumatic vertigo to develop?

A

Severe vertigo x days-week
Same sided deafness

Cupulolithiasis- otoconia become detached during trauma

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111
Q

How is traumatic vertigo Tx

What do PTs w/ perilymphatic fistula present complaining of?

A

Diazepam/Meclizine
Vestibular therapy

SHL and vertigo worse w/ straining

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112
Q

What are 4 scenarios that can cause the development of perilymphatic fistulas?

How are these cases Tx

A

Ear slap
Barotrauma (fly/scuba)
Weight lifting valsalva
Stapedectomy complication

Head elevation w/ bed rest
Tx failure: middle ear exploration w/ grafting to close window

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113
Q

How does Migrainous Vertigo present

What may be seen in FamHx of these PTs

A

Episodic vertigo w/ HA
Phono/Photo-phobia
Sxs worse w/ sleep deprivation/stress, caffeine, chocolate and ETOH

Motion intolerance

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114
Q

How does migrainous vertigo differ from Menieres?

How are these PTs managed?

A

No HL/tinnitus

Antimigraine prophylaxis
Lifestyle changes

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115
Q

How do PTs w/ Superior Semicircular canal dehiscence present?

What form of imaging is needed?

How are they Tx?

A

Vertigo after loud noises or straining w/ CHL
Autophony

CT and VEMPs

Surgical resurface/plugs

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116
Q

How do nystagmus’ from central vertigo etiologies appear on PE?

What form of testing is useful for these cases?

A

Non-fatigable
Vertical and w/out latency
Not suppressed w/ fixation

ENG

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117
Q

Lesions on CN8 and central audiovestibular pathways cause ? issues

Characteristics of this type of lesion

A

Neural HL and vertigo

Dec speech discrimination
Auditory adaptation

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118
Q

What type of test is done to distinguish between cochlear from neural HL?

What type of imaging is needed and of ? structures?

A

Brainstem Auditory Evoked Response

MRI of internal AC, cerebellopontine angle and brain

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119
Q

What are the 3 d/os of the central auditory and vestibular system?

What is one of the MC types of intracranial tumors?

A

Vestibular schwannoma (acoustic neuroma)
Vascular compromise
MS

CN8 schwannomas (vestibular/acoustic neuroma)

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120
Q

Since most vestibular/acoustic schwannomas are unilateral, what condition causes bilateral growths?

What other types of growths may be seen intracranial/spinal?

A

Neurofibromatosis Type 2

Meningiomas

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121
Q

Where do vestibular/acoustic neuromas grow and cause issues?

What is the typical auditory Sx that PTs complain of?

A

Start in internal AC, grow into cerebellopontine angle, compressing pons= hydrocephalus

Unilateral HL w/ deteriorating speech discrimination

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122
Q

Any PTs presenting w/ sudden unilateral and asymmetric hearing loss need to have ? r/o

Prior to radiotherapy and surgery, what medication can be attempted for Tx of Neurofibromatosis Type 2 growths?

A

Intracranial mass via MRI w/ gadolinium

Bevacizumab- vascular endothelial growth blocker

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123
Q

How are PTs w/ acoustic neuromas Tx/managed?

? etiology of central vertigo can present nearly identical to Meniere’s w/ F>M and a genetic component?

A

ASx: observe w/ annual MRI
Sxs: excision, radiation and annual MRI

MS

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124
Q

How does MS induced vestibular issues present?

These PTs often present w/ ? associated Sxs from adjacent CNs?

A

Episodic vertigo
Chronic imbalance
Unilateral/rapid onset SHL

Hyper/poacusis
Facial numbness
Diplopia

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125
Q

? is a common cause of vertigo in elderly PTs after posture/neck extension movements?

What image is ordered prior to ? Tx

A

Vertebrobasilar insufficiency

MRA prior to empiric Tx w/ vasodilators, ASA

126
Q

Hemifacial spasms and tic douloureux are examples of manifestations caused by ?

A

Vascular loops impinging on brainstem

127
Q

How is Acute Peripheral Vertigo Tx

A

Object focus w/ blank back ground w/ slow head movements; inc speed w/out exacerbating N/V

128
Q

How is Chronic Peripheral Vertigo Tx

A

Head/eye movements while standing and walking fwd/back including uneven surfaces

129
Q

How are Bilateral Vestibular injuries Tx

A

No possibility for adaption, no improvement will occur

Fall prevention education*

Dark/uneven surface particularly challenging

130
Q

How is central vertigo Tx?

A

Gait/balance exercise w/ head/eye movements

Take longer for improvement

131
Q

Path of sound through ear

A

Sound waves of varying pressure heights enter

TM vibrates

Ossicles amplify vibration

Vibration passes through oval window to move fluid in vestibuli

Cochlear membrane movement bends hairs in basilar membrane

132
Q

What are the two types of HL and parts of ear involved

How are these seen on Weber/Rinne tests

A

Conductive- external/middle ear
Sensorinureal- degeneration of Cochlea, CN8 lesion

CHL, Weber louder in affected side/BC>AC
SHL, Weber louder in normal ear/AC>BC

133
Q

What are the 4 causes of conductive hearing loss?

A 
Obstruction (MCC of CHL)
Mass loading (middle ear effusion)
Stiffness effect (otosclerosis)
Discontinuity (disrupted ossicles)
134
Q

Transient CHL is usually d/t ?

Persistent CHL is usually d/t ?

A

Impaction
ETD from URI

Chronic ear infection
Trauma
Otosclerosis

135
Q

SHL is d/t ? while NHL is d/t ?

PTs w/ unilateral or asymmetric sensorineural HL suggests ? issues?

A

S: deteriorated cochlea (loss of hairs in organ of Corti)
N: lesion on CN8 or higher

Lesion proximal to cochlea (acoustic neuroma)

136
Q

What is the first and second MC form of SNHL?

SHL is not medically or surgically correctable except for ? and ? can be used

A

Presbyacusis- loss of high frequency (bird chirp, phone)
2nd: noise trauma

Sudden SHL, CCS used

137
Q

NHL can be due to lesions located where?

What other non-lesion causes can lead to this type of HL?

A

CN8
Auditory nuclei/cortex
Ascending tract

Acoustic neuroma
MS
Auditory neuropathy

138
Q

What is the MC complaint of PTs w/ presbycusis?

Sounds above ? dB level can cause damage to cochlea

A

Lost speech discrimination in noisy environments

85dB

139
Q

Noise trauma induced HL usually begins to be seen at ? frequency level?

Head trauma has an affect on the inner ear similar to ? type of trauma?

A

4000Hz

Severe acoustic

140
Q

Certain degrees of SHL may be noted after simple concussions but is frequent after ?

What are the 3 most ototoxic medications?

A

Skull Fx

Aminoglycosides
Loop diuretics
Antineoplastics (Cisplatin)

141
Q

How do PTs w/ sudden SHL present

How are these PTs managed

A

Sudden, unilateral HL in PTs >20y/o from infection/internal auditory artery occlusion

Prompt PO Prednisone w/ 10 day taper
Equal/better outcome w/ intratympanic CCS

142
Q

Medical Tx for sudden SHL needs to be started w/in ? of start

What other test needs to be ordered w/ medication

A

<6wks

Audiogram

143
Q

SHL is associated w/ ? autoimmune d/os?

What two issues can usually be seen accompanying the HL?

A

SLE
Granulomatosis w/ polyangitis (Wegener granulomatosis)
Cogan Syndrome- HL, keratitis, aortitis

Dysequilibrium
Posture instability

144
Q

What lab tests are elevated in PTs w/ autoimmune induced HL?

What is the first and second line Tx?

A

ANA RF ESR

1st: PO Prednisone every morning x 2-3wks
2nd: Cytotoxic meds (Methotrexate)

145
Q

What can cause PTs to experience pulsatile tinnitus?

What form of imaging do these PTs need?

A 
Glomus tumor
Venous sinus stenosis
Carotid vaso-occlusive dz
AV malformation
Aneurysm

MRA and venography

146
Q

What causes PTs to experience staccato tinnitus?

What medication can be used for tinnitus management?

A

Palatal myoclonus- soft palate movement

Nortriptyline 50mg qHS (every bed time)

147
Q

What images are ordered for PTs w/ unilateral tinnitus w/out obvious precipitating factor?

Define Recruitment

A

MRA/MRV
Temporal bone CT

PTs w/ cochlear dysfunction experiencing hyperacusis to loud sounds and reduced sensitivity to softer ones

148
Q

Sudden onset unilateral HL, regardless if tinnitus is present, can present ? issues

What do these PTs present complaining of?

A

Viral infection
Vascular accident

Poor sound localization
Difficulty hearing w/ background noise

149
Q

Gradual loss of hearing can be due to ? issues

What CNs can be involved w/ one of these etiologies?

A

Otosclerosis
Noise induced loss
Vestibular schwannoma
Meniere dz

Vestibular schwannoma causing neuropathy w/ CN 5 or 7

150
Q

Adult PT w/ HL and unilateral serous effusion should have ? next step taken

Audiology assessments consist of what 4 tests?

A

Fiberoptic exam of nasopharynx for neoplasms

Pure tone air/bone conduction
Speech reception threshold
Tympanometry
Acoustic reflexes

151
Q

Audiogram thresholds are tested between ? ranges

These thresholds are measured in ? and relate to ? conclusion

A

250-8000 Hz

dB, higher threshold= poorer hearing

152
Q

Define OSHA criteria for a STS

Audiogram symbols

A

> 10dB at 2-4000 Hz or,
Sum from 2-4000Hz is >30dB

Blue X- L ear, air conduction
Red O- R ear, air conduction
Blue >- L ear, bone conduction
Red

153
Q

What are the two axis of the tympanometry?

Define Decapascal

A

X- pressure against TM
Y- compliance of TM

Unit of pressure equal to 1 Newton/sq meter

154
Q

Type A Tympanogram

A

Normal

Peak near 0 decapascal
Compliance .2-1.8ml
Result: no middle ear pathology, intact TM, normal ET function
+HL= SNHL

155
Q

Type As Tympanogram

A

Peak near 0 daPA, but dec compliance near 0.2ml

Results: ossicular fixation, otosclerosis or TM scars
Normal ET function

156
Q

Type Ad Tympanogram

A

Peak pressure near normal, peak pressure above 2.0, extremely high compliance

Result: ossicular disarticulation/chain discontinuity
Normal ET function

157
Q

Type B Tympanogram

A

Flat, no/poor peak w/ negative middle ear pressure > -200daPa
Little to No TM mobility present
Compliance below normal

Result: Fluid in middle ear or TM perf

158
Q

Type C Tympanogram

A

Retracted TM or ET dysfunction
Define peak on negative side, indicated negative mid ear pressure
Normal peak compliance

Result: ET dysfunction w/ mild CHL and normal hearing

159
Q

What are the names of the 4 sinus cavities?

What two are less developed in kids?

A

Frontal Ethmoid Sphenoid Maxillary

Frontal and sphenoid

160
Q

Define the Ostiomeatal Complex

What is the function of this structure?

A

Connection between frontal, anterior ethmoid air cells and maxillary sinus and the middle meatus

Airflow and mucociliary drainage

161
Q

PTs w/ ? presentation suggests a bacterial infection instead of acute viral rhinosinusitis

What “may be” the most effective management strategy against viral rhinitis?

A

Purulent nasal d/c

Annual influenza shot

162
Q

What is the first medication for the Tx and prevention of influenza for high risk PTs

These high risk PTs include ?

A

Oseltamivir via neuroamidase inhibition

Young kids
Pregnant women
>65y/o

163
Q

Although not proven to prevent the common cold, daily intake of ? >75mg has proven to shorten the course

What is used for Sx relief instead of NSAIDs for PTs w/ common cold?

A

Zinc acetate

3-5% hypertonic solution
PO pseudoephedrine

164
Q

What are two nasal sprays that can provide rapid relief of common cold Sxs but only used for <3days?

If these meds are used chronic, what condition can PTs develop?

A

Oxymetazoline
Phenylephrine

Rhinitis medicamentosa

165
Q

What are 3 medical options for Pts during the withdrawal phase of rhinitis medicamentosa?

What is a ‘well-accepted’ complication of acute viral rhinitis and what PE finding suggests this Dx

A

Flunisolide (CCS)
Anticholinergic- Ipratropium
PO Prednisone

Acute bacterial rhinosinusitis;
Sxs >10days
Green/yellow nasal secretion
Unilateral tooth pain

166
Q

Where is the largest ostiomeatal complex located?

This largest complex is the drainage point for ? sinuses

What is the only sinus cavity not drained by the ostiomeatal complex and where does it drain to?

A

Deep to middle turbinate of middle meatus

Maxillary, Ethmoid, Frontal

Sphenoid- between septum/superior turbinate

167
Q

What microbes can cause Community Acquired ABRS

What microbes cause Hospital acquired ABRS?

A

Strep pneumo
H influenza
Staph A
M catarrhalis

Pseudomonas/Gram negs
Staph A

168
Q

How is bacterial rhinosinusitis distinguished from viral etiologies?

What are the time frames for Dx acute, subacute and chronic rhinosinusitis?

A

Sxs >10 days
Worsening Sxs w/in 10 days after improvement
Severe Sxs/>102.2* fever and facial pain/discharge x 4days

Acute: <4wks
Sub: 4-12wks
Chronic: >12wks

169
Q

? is the MC form of acute bacterial rhinosinusitis

What is this MC form’s etiology

A

Maxillary sinusitis

Largest sinus w/ single drainage path

170
Q

S/Sxs of Acute Maxillary Sinusitis

? other form of sinusitis usually accompanies Maxillary Sinusitis?

A

Unilateral facial fullness
Pain over upper incisor/canine d/t CN5 on floor of sinus

Ethmoid

171
Q

Pt w/ HA in middle of head may have ? type of sinusitis

This form of sinusitis is usually seen in the setting of __-sinusitis

A

Sphenoid

Pan sinusitis

172
Q

PT w/ painful/tender forehead may have ? type of sinusitis and has pain elicited by ?

? type of sinusitis presents w/out usual Sxs, fever, and may be in PTs w/ NG tubes

A

Frontal sinusitis, tapping on orbital roof below medial eyebrow

Hospital Associated sinusitis

173
Q

What are expected PE findings of acute rhinosinusitis

Although heavily discouraged, if x-ray is ordered to view maxillary sinus, what view is ordered?

A

Pain w/ palpation/bending*
Narrowed middle meatus
Hypertrophic inferior turbinate
Septal deviation/polyps

Upright water’s view

174
Q

How are PTs w/ bacterial rhinosinusitis Tx

Since ABX are controversial, when are they used and recognized as the most cost-effective Tx strategy?

A 
NSAIDs 
PO Pseudoephedrine (systemic decongestant)
Nasal oxymetazoline (topical decongestant)
Mometasone furoate (intranasal CCS) for facial pain

Sxs >10days
Fever and facial pain/swelling
ImmDeficient

175
Q

What ABX are recommended for use if Tx ABRS?

Due to increased resistance and poor sinus penetration, what are three ABX that are not used for Tx?

A

Augmentin
PCN allergy/dec liver function- Doxy or Clinda w/ Cephalosporin (Cefixime)

Macrolides (Azithromycin)
TMP/SMX
2nd/3rd Gen cephalosporins

176
Q

How does acute bacterial rhinosinusitis lead to orbital complications?

If this complication develops, PTs will present complaining of ?

A

Via ethmoid sinus through lamina papyracea (thin bone in medial orbital wall)

Proptosis
Restricted gaze
Orbital pain

177
Q

What part of the face is MC involved in Osteomyelitis complications from ABRS?

This condition creates tender swelling of forehead that is AKA ?

A

Frontal sinus

Pott Puffy Tumor

178
Q

PT presents w/ proptosis, ophthalmoplegia and pain w/ medial gaze indicates ? issue

What happens if these cases are delayed and do not receive prompt decompression?

A

Subperiosteal abscess (orbital abscess)

Permanent visual impairment and “frozen globe”

179
Q

How is ABRS extension into intracranial space visualized?

This form of imaging is needed to evaluate ? area

A

MRI

Danger Triangle

180
Q

How do intracranial spread of ABRS occur and what do the different types of spread cause?

A

Hematogenous- cavernous sinus thrombosis; meningitis

Direct extension- epirdural/intraparenchymal abscesses

181
Q

What are the S/Sxs of a cavernous sinus thrombosis

What image is used to confirm Dx and how is it Tx

A

Ophthalmoplegia
Chemosis
Visual loss

MRI; IV ABX

182
Q

Although typically silent, how do frontal epidural/intracranial abscesses present?

What microbe is usually the cause of nasal colonization/vestibulitis?

A

AMS Fever Severe HA

Staph A

183
Q

How is nasal vestibulitis/nasal colonization Tx

What is added if cases are recurrent and used to eliminate carrier states?

Why do these cases need to be Tx quickly and effectively?

A

Dicloxacillin w/ Mupirocin
Chlorhexidine facial washes

Rifampin

Prevent spread into cavernous sinuses and intracranial structures

184
Q

Define Rhinocerebral Mucormycosis

What microbe is usually the cause?

What are the feared end results of these cases?

A

Fungal infection in ImmComp PTs

Aspergillus or Mucor/Absidia/Rhizopus

Spread to optic nerve/thrombosis/seizure/stroke

185
Q

How do PTs w/ rhinocerebral mucormycosis present?

What is the classic PE finding of this Dx?

A

Sxs like ABRS but more severe facial pain w/ clear/straw nasal d/c

Black eschar on middle turbinate

186
Q

What procedure is done to confirm Dx of rhinocerebral mucormycosis?

How is it Tx w/ meds?

How is it Tx w/ surgery?

A

Nasal biopsy for silver stains showing branching non-septate hyphae w/ necrosis

Amphotericin B- DOC
Voriconazole
Caspofungin

Wide debridement w/ medial maxillectomy

187
Q

Since rhinocerebral mucormycosis is almost exclusively seen in ImmComp PTs, what are the mortality rates of the different compromised?

What is the source of dust mite allergies?

A

Diabetics- 20%
Kidney dz- >50%
AIDS/heme malignancy w/ neutropenia- 100%

Protein in mite feces/decaying bodies

188
Q

Allergic rhinitis is associated w/ ? Dx

Seasonal allergic rhinitis is MC caused by ?

What are the etiologies of year round allergies?

A

Asthma

Pollen/Spores

Dust Mites Pollution Dander

189
Q

? Dx has strong FamHx of Atopy?

? is the mainstay of Tx of this condition

A

Allergic rhinitis
Atopy- genetic tendency to develop allergic dzs

Intranasal CCS

190
Q

What are examples of intranasal CCS used for Tx allergic rhinitis

Since these usually don’t provide relief until after 2wks of used, what can be given for immediate relief?

What medication is reserved for last and only for PTs that can’t tolerate s/e of PO meds?

A 
Beclomethasone
Flunisolide
Mometasone furoate
Budesonide
Fluticasone propionate

PO antihistamines:
Non-sedate: Des/Lorata/Fexofenadine
Min-sedate: Cetirizine
Sedate: Brom/Chlorpheniramine

Azelastine nasal spray

191
Q

What adjunct meds are used for the Tx of allergic rhinitis?

A

Anti-leukotrienes:
Montelukast

Mast cell stabilizers:
Cromolyn sodium
Soidum nedocromil

192
Q

When Tx allergic rhinitis, what med is best for optho Sxs?

What is the most effective method for relief of Sxs?

A

Mast Cell stabilizer:
Cromolyn sodium

Allergen avoidence

193
Q

If PTs have extreme Sxs of allergic rhinitis, consider referral to allergist for ? test

What are the 4 types of non-allergic rhinitis?

A

RAST: Serum Radioallergosorbent Test

Gustatory- spicy food
Medicamentosa- Afrin
Vasomotor- hyper reactivity
Occupational- smell/fumes

194
Q

Allergic rhinitis needs to be carefully r/o from ? rhinitis?

This DDx is due to ? and often seen as ? in elderly PTs

A

Vasomotor

Sensitivity of vidian nerve
Clear rhinorrhea

195
Q

What is the MC s/e of using intranasal CCS for the Tx of allergic rhinitis?

What medication is better for Tx of vasomotor rhinitis?

A

Epistaxis

Intranasal anticholinergic- Ipratropium Bromide

196
Q

Epistaxis MC occurs from ? location

If pressure x 15min fails to stop bleeding, what is the next step?

A

Unilateral anterior cavity from Kiesselbach plexus

Topical sympathomimetics
Nasal tamponade

197
Q

Define Osler-Weber-Rendu Syndrome

What two types of medication classes are associated but not a cause of epistaxis?

A

Hemorrhagic telangiectasia causing epistaxis

Anti-coag/platelet

198
Q

Posterior nosebleeds come from ? plexus and are usually due to ?

Steps for anterior epistaxis Tx

A

Woodruff plexus
Artherosclerosis and HTN

1- PPE
2- Pressure x 15min in sitting/leaning position
3- Phenylephrine/Oxymetazoline w/ 15min pressure
4- Oxymetazoline or Tera/Lidocaine
5- Cauterize w/ silver nitrate;
Patch w/ GelFoam
6- Pack

199
Q

How are anterior epistaxis cases packed?

A

ABX- prevents TSS
Insert along floor
Push w/ speculum
Use 2x floor length, grasp midpoint and insert posteriorly

200
Q

How are posterior epistaxis cases managed?

What is the final disposition for these PTs?

A 
Tamponade
Packing
Double balloon
Ligate- internal maxillary, facial, ethmoid arteries
Rarely- external carotid

Admit- vasovagal HOTN possible

201
Q

After posterior epistaxis packing, ? needs to be avoided?

What meds are given to these epistaxis PTs?

A

Spicy food
Tobacco

Opioids- relief and BP

202
Q

Epistaxis lasting longer than ? need to go to ER

PTs w/ nasal Fx need to have ? Dx r/o during PE?

A

15min

Zygomatic complex Fx causing step offs/numbness

203
Q

Septal hematomas form between ? structures?

What is the concern w/ these injuries?

A

Perichondrium and Cartilage

Necrosis to perforation

204
Q

Septal hematomas are at risk for becoming ? or infected w/ ? and prevented w/ ? med

How are they managed?

A

Saddle Nose
Staph A
Cephalexin/Clinda

InD bilaterally

205
Q

How long after nasal Fxs are closed reduction attempted?

How are complex Fxs of the midface classified?

A

<7days of injury under general anesthesia

Le Fort System:
1- horizontal
2- pyramidal
3- craniofacial

206
Q

Anterior epistaxis that are not controlled by tamponades need to have packing placed to occlude ? structure

? is the MC Fx bone in body

A

Choana- opening between nasal cavity and nasopharynx

Nasal pyramid

207
Q

What must be r/o on all nasal Fxs?

Where does septum receive nutrients from?

A

Septal hematoma- looks like widening of anterior septum posterior to columella

Mucoperichondrium

208
Q

Asthma + nasal polyps= no ? meds

This can cause ? triad

A

ASA

Samter- Polyp Asthma Spasms

209
Q

? is the best known precancerous lesion of the mouth

This finding represents ? pathological/histological occurrence?

A

Leukoplakia

Hyperplasia of the squamous epithelium

210
Q

What is the sequence of changes at the cellular layer in leukoplakia?

Although associated w/ Ca, what non-malignancy condition can it be seen in?

A

Hyperplasia
Dysplasia
Carcinoma in situ
Malignant tumor invasion

Hyperkeratosis from chronic irritation

211
Q

What oral finding is similar to leukoplakia but more erythematous and more likely to show dysplasia/carcinoma changes?

If adenopathy is found during an exam, what is the next step for these Pts?

A

Erythroplakia

FNA

212
Q

? is the MC PO Ca and how does it appear on PE

? RFs indicate PT may have this Dx

A

SCC- raised firm and white at base w/ pain and >4mm

Tobacco and ETOH

213
Q

How is SCC of the mouth Tx by size

A

<4mm deep- unlikely to metastasize
<2cm- local resection
Pos margins/metastatic- radiation

214
Q

Oral lesions lasting longer than ? should be considered for referral

? is believed to the etiology of nearly 70% of oropharyngeal SCC development?

A

> 2wks to OMFS/ENT

HPV-16

215
Q

What are the ABCDEs of melanomas?

Define melanosis

A 
Assymetry
Border irregularity
Color variation
Diameter increase
Elevation

Symmetric dark patches in oral mucosa in PTs w/ darker skin

216
Q

Define Melanotic Macule

? is the MC site to find amalgam tattoos?

A

Symmetric shape w/ sharp borders in adults that don’t change

Mandibular arch

217
Q

Define Fordyce Spots

Define Lichen Planus and the two types

A

Benign neoplasm of sebaceous glands at border of vermillion/buccal mucosa

Wax/waning inflammatory condition in PTs >40y/o
Reticular: painless white striae or buccal papules
Erosive: painful erythema/ulcers w/ white striae surroundings

218
Q

How is Lichen Planus Dx

How are these PTs managed?

A

Exfoliative cytology or biopsy

Topical CCS
Cyclosporin
Retinoids
Tacrolimus- most evidence

219
Q

? other Dx may be present in PTs w/ thrush

What are the 4 types of Candidiasis that can cause thrush?

A

Angular cheilitis

Albicans*
Glabrata
Krusei
Tropicalis

220
Q

What are the two different presentations of oral thrush?

A

Pseudomembranous- MC overall; white plaques on mucosa

Atrophic- denture stomatitis, MC in adults; erythema w/out plaques

221
Q

How is thrush Dx

What are the known RFs that can lead to it’s development?

A

KOH- budding yeast, pesudohyphae, non-septate mycelia, spores

Dentures
Debilitated w/ poor hygiene
DM
Anemia
Chemo/radiation
CCS
Broad ABX
222
Q

How is thrush Tx in infants and kids?

A

Infant:
Topical antifungal
Nystatin
Refractory cases- gentian violet, PO Fluconazole

Older kid w/ <50% mucosa involved and no erosion:
Topical nystatin
Clotrimazole

Older kid w/ >50% mucosa involved, erosive or refractory:
Systemic therapy
Fluconazole

223
Q

How are PTs w/ HIV and thrush Tx

PTs that wear dentures and develop thrush are Tx w/ ?

A

Fluconazole
PO Itraconazole (refractory)
Voriconazole (resistant to first line -azole)

Nystatin powder

224
Q

How are adults w/ Thrush Tx

A

Fluconazole
Ketoconazole
Nystatin rinse

Chlorhexidine
Half H2O2 rinses
Nystatin powder

225
Q

Aphthous ulcers have a known incidence finding due to ?

Where are they found and how do they appear

A

HPV-6

Fee moving, non-keratinized mucosa (+buccal/labia/ventral tongue, - gingiva, palate)
Yellow/gray center w/ red halo

226
Q

Size criteria for minor and major aphthous ulcers

What is the major/most common predisposing factors to an aphthous eruption?

A

Minor: <1cm
Major: >1cm

Stress
Viral rhinitis
Bedtime after 11pm

227
Q

How are aphthous ulcers Tx/managed?

What medication is used for maintenance therapy and recurrent ulcers?

What is used for recurrent ulcers in HIV PTs?

A 
Triamcinolone acetonide
Fluocinonide 
7d Prednisone taper
Diclofinac in hyaluronan
Amlexanox

Cimetidine

Thalidomide

228
Q

? is MC cause of oral ulcers

What are two GI Dxs that can cause ulcers to appear

What vitamin deficiencies can lead to eruptions?

A

Recurrent Aphthous stomatitis

Celiac/IBD

B 1,2,6, 12
Fe/Zn
Folic acid

229
Q

Herpetic ginigvostomatitis is from ? virus

Where do they appear and what do they look like?

A

HSV-1

Clustered vesicles on vermilion border
Rupture, ulcer and crust <48hrs, heal 7-10d

230
Q

? are the precipitating factors that can lead to a herpetic gingivostomatitis eruption?

HOw is a Dx confirmed from clinical suspicion?

A 
UV light
Trauma
Fatigue
Stress
Menstruation

Multi-nucleated giant cells on Tzanck smear

231
Q

How are PTs w/ Herpetic Ginigvostomatitis Tx

How does Varicella Zoster appear on exam?

A

Acyclovir
Valacyclovir
Only effective if initiated <48hrs of prodrome Sxs

Vesicles and erosions grouped unilaterally on dermatome in PT w/ Hx of chicken pox

232
Q

Define Atrophic Glossitis

What are the causes of this condition?

A

Inflammatory d/o of tongue leading to atrophy of papillae leading to smooth/red tongue

Fe/B12/Folic acid 
Sjogren syndrome
Candidiasis
Protein/calorie malnutrition
Celiac dz
233
Q

Loss of ? part of the tongue leads to geographic tongue?

This finding is associated w/ ? other d/os?

A

Filiform papillae

Candidiasis
Reiter syndrom
Psoriasis
Lichen planus

234
Q

How are tonsils graded?

A 
0- no tonsils
1- hidden behind pillars
2- extend to pillar
3- extend beyond pillar
4- extend to midline
235
Q

Define Centar Criteria

How do scores correlate to Tx

A 
3/4 suggest GAS Dx:
Fever >100.4
Anterior cervical adenopathy
No cough
Exudate from tonsils
Modified: <15y/o or >44y/o

0-1: no Tx, rapid Ag, culture
2-3: culture/Ag test
4 or +: empiric Tx w/out Ag/culture results

236
Q

Identifying and Tx GAS infection of the throat is important for prevention of ? two sequelae?

Why is there hesitancy to giving ABX to all sore throats?

A

Rheumatic fever
Glomerulonephritis

Developing ABX resistant Strep Pneumo

237
Q

Lymphadenopathy and shaggy, white/purple tonsil exudate moves Dx from GAS to ?

What lab results suggests EBV etiology?

A

Mono

Lymphocyte to WBC ratio >35%

238
Q

PTs w/ Mono and underlying tonsilitis need to avoid ? ABX

Alcoholics w/ low fever and gray tonsilar pseudomembrane don’t have Mono or Strep but ? Dx

A

Ampicillin- can cause rash that is mis-Dx as PCN allergy

Diphtheria

239
Q

What are the MC pathogens other than GABHS in a sore throat DDx?

What PE finding suggests a viral etiology?

A

N gonorrhoeae
Mycoplasma
Chlamydia trachomatis

Rhinorrhea
Lack of exudate

240
Q

? 3 microbes can cause PTs to appear to have pharyngitis from GABHS?

What ABX is used instead

A

Corynebacterium diphtheria
Anaerobic streptococci
Corynebacterium haemolyticum

Erythromycin

241
Q

What ABX is the TxOC for GAS

A

Pen VK 1.2M units
Cefuroxime
IM Benzathine Pen G- compliance/crowded living concerns

PCN sensitivity:
Clinda/Azithromycin

Peds <27kg:
Pen VK
Bicillin C-R
PCN Sensitivity: Azith

242
Q

How are PTs w/ Mono Tx

How long do these PTs need to avoid sports/contact activities?

A

NSAID/lozenges
CCS

Mod sports x 3wks Sx onset
Strenuous/contact x 4-6wks

243
Q

Peritonsillar Cellulitis and Abscesses are AKA ? and develop when ?

What do PTs present w/?

A

Quinsy tonsil; infection penetrates tonil capsule and surrounding tissue

Odynophagia
Trismus
Medial deviation of soft palate
Hot potato voice

244
Q

After Tx, if peritonsillar cellulitis doesn’t resolve it can turn into ?

This Dx is confirmed by doing ? procedure

A

Peritonsillar abscess

Aspirating pus from peritonsillar fold superior and medial to upper tonsil pole w/ 19-21g

245
Q

When aspirating pus from peritonsillar abscess, needle depth should not exceed ? because ?

Since most PTs are seen in ER, what meds are they given?

A

1cm
Internal carotid lies medially

Amoxicillin
Clindamycin

246
Q

All peritonsillar abscesses must be Tx via ? 3 methods?

When can these PTs be monitored w/ IV ABX prior to Tx

A

Needle aspiration
InD
Tonsillectomy

No airway compromise, septicemia or trismus

247
Q

Criteria for adults to be considered for Tonsillectomy only after observation?

How many minor salivary glands are there?

A

<7 infections in past year
<5 infections in past 2yrs
<3 in past 3 years

750-1000 submucosally in lips-trachea

248
Q

What glands does Sialadenitis involve?

What causes this condition to develop?

A

Parotid
Sub-mandibular

Dehydration
Sjogren
Staph A- MC microbe

249
Q

How is Sialadenitis Tx

If the above medical Tx fail, what Dx need to be considered?

A

Sialagogues- lemon drops
IV Nafcillan

Abscess
Stricture
Stone/tumor

250
Q

How is Suppurative Saladenitis different?

Since an immediate referral is needed, what ABX are PTs placed on?

A

No pus is expressed from stenson papilla
No response to hydration/ABX

Nafcillin and either Metronidazole or Clindamycin
ImmComp PT: Vancomycin

251
Q

Sialolithiasis MC affects ? structure?

What imaging is used and what will be seen depending on the structure involved?

A

Wharton duct

CT-
Wharton- large, radiopaque
Stenson- small, radiolucent

252
Q

How is Sialolithiasis Tx based on size of stone

A

<2cm from duct: sialagogues, massage, InD

> 2cm from opening: sialoendoscopy; management of choice if chronic case

253
Q

What are 3 examples of drugs that have caused parotid gland enlargement?

Salivary gland tumor and ? PE finding correlates to probable malignancy?

A

Thioureas
Iodine
Phenothiazine/cholinergics

CN7 involvement

254
Q

Vocal cords are attached to ? structures

How is pitch controlled?

A

Arytenoid/Thyroid cartilage

Vocal fold tension-
Tight= higher
Larger/thicker folds in men= deeper pitch

255
Q

What structures help produce vowel sounds of words?

What structures help w/ enunciation?

A

Pharynx muscles

Face Tongue Lip muscles

256
Q

What are the primary Sxs of laryngeal Dz

What causes these Sxs

A

Hoarseness
Stridor

Hoarse- abnormal vibration of vocal folds

257
Q

What causes ‘breathy’ voices?

What causes ‘harsh’ voice?

What causes a ‘rough’ voice?

A

Breathy- paraylsis or mass

Harsh- stiff w/ irregular vibrations, laryngitis, malignancy

Rough- edematous folds

258
Q

Define Stridor

What is the opposite of stridor?

A

High pitch sound of inspiration d/t narrowed glottis at/above vocal folds

Expiratory/biphasic stridor- narrowing below vocal folds

259
Q

PTs w/ hoarseness lasting longer than ? need to be referred?

If co-existing Sxs such as ? are present, worry level increases

A

2wks

Severe cough
Hemoptysis
Unilateral throat/ear pain
Dys/Odynophagia
Unexplained weight loss
260
Q

? is the MC cause of hoarseness

This MC cause is usually due to ?

A

Acute laryngitis <3wks

Vocal abuse
Post-URI x 7 days

261
Q

What two microbes are most likely to cause acute laryngitis?

? medication may be used to shorten the course of hoarseness due to acute laryngitis and what does it provide?

A

M catarrhalis
H Influenza

Erythromycin
Horaseness at 7d
Cough at 14d

262
Q

What PT population may benefit from a IM CCS injection to help Tx acute laryngitis?

Why are most people with this Dx recommended to avoid straining their voice?

A

Pro singers

Vocal cord hemorrhage
Poly/Cyst formation

263
Q

What are the etiologies of chronic laryngitis?

Time frame for a Dx of chronic laryngits

A 
Toxins
GERD
Post-nasal drip
ETOH abuse
Chronic vocal strains

> 3wks

264
Q

Tobacco use + chronic laryngitis can cause ? development to occur

How do PTs w/ Epi/Supraglottits present and ? presentation is a red flag?

A

Keratosis
Polypoid corditis

Odynophagia OOP to exam
Drooling

265
Q

Epiglottitis is more likely to occur in ? PT population

Upon Dx, PTs are admitted and Tx w/ ? ABX?

A

DM

Ceftriaxone or,
Cefuroxime and,
Dexamethasone

266
Q

What are the indications that a PT w/ epiglottitis needs to be intubated?

How do PTs w/ Laryngopharyngeal Reflux present?

A

Dyspnea
Rapid sore throat progression
Endolaryngeal abscess seen on CT images

Hoarseness
Persistent cough
Esophageal spasm
Globus sensation in throat

267
Q

What is the best method for documenting reflux to the pharynx in PTs w/ Laryngopharyngeal Reflux?

The test is considered the best option for evaluation?

How are PTs Dx?

A

24hr pH monitor but, difficult and not widely used

Double pH probe

Omeprazole x 3mon
H2 antagonist- less efficacy

268
Q

? are the MC lesions of the larynx

Where do these MC lesions tend to develop?

A

Papillomas

Ciliated/Squamous epithelium junctions

269
Q

Recurrent papillomas are almost always due to ?

What medication has proven effective to Tx recurrent respiratory papillomatosis

What is the risk of using this medication?

These are the MC lesion of the larynx and also the MC ?

A

HPV 6,11

Cidofovir- cytosine nucleotide analog used to Tx CMV rhinitis

Adenocarcinoma development

Benign laryngeal tumor in kids

270
Q

What PT population is likely to have cell transformation of recurrent respiratory papillomatosis?

How do PTs present and what would be seen?

A

Smokers

Hoarse to stridor progression
Multiple warty lesions on cords

271
Q

How are papillomatosis cases Tx?

How can this condition be prevented?

A

Laser/Cold knife

Gardasil 9

272
Q

What are the goals of papillomatosis Tx?

What are the 4 traumatic but benign lesions of vocal cords?

A

Voice development
Structure preservation
Avoid tracheotomy

Nodule Polyp Cyst
Polypoid corditis

273
Q

Vocal fold nodules are AKA in adults and AKA in kids

What type of appearance do they develop into?

A

Adult- singer nodule
Kid- screamer nodule

Smooth paired lesions at junction of ant/post folds

274
Q

How to vocal fold polyps appear

These can be a common sequelae in PTs after ?

A

Unilateral mass within superficial lamina propria of folds

Vocal fold hemorrhage

275
Q

Where do vocal fold cysts tend to develop?

Why is Tx of these difficult?

A

Mucus secreting glands in inferior vocal folds

Leave behind sulcus/scar resulting in permanent/chronic dysphonia

276
Q

Laryngeal leukoplakia of the vocal cords have common associations w/ ? PT populations?

Almost all PTs will get ? procedure and ? can be the initial discovery

How are these cases Tx

A

Smokers

Direct laryngoscopy w/ biopsy; SCC

Smoking cessation
PPI (mainstay)
Radiation

277
Q

How does SCC of the larynx present

SCC of the larynx is the MC ?

A

Smoker w/ hoarsenss >2wks
Throat/ear pain w/ swallowing
Mass/hemoptysis

Malignancy of larynx

278
Q

SCC of the larynx can be due to ? infection

This Dx has the strongest prevalence in ? PT population?

A

HPV 16, 18

Non-smoker

279
Q

What is the MC initial complaint of PTs w/ SCC in the larynx

What is the difference between glottic cancer and supraglottic cancer?

A

Change in voice quality

True vocal fold- mobile cords, rarely metastasize
False/aryepiglottic/epiglottis- metastasize early in dz

280
Q

When do PTs w/ laryngeal SCC need a CXR?

What are the 4 goals of Tx

A

Level 6 nodes around trachea/thyroid
Level 4 nodes inferior to cricoid cartilage along internal jugular

Cure
Preserve swallowing
Preservation of voice
Avoiding tracheostoma

281
Q

Table 8-1

A

Slide Deck 6

282
Q

How are supra/glottic Ca Tx

If PT has vocal cord paraylsis from damaged vagus/recurrent nerves, how doe they present?

A

Early- radiation, standard of care
Late/large/metastasis- multi-modal Tx

Breathy dysphonia
Effortful voice

283
Q

? is the MC cause of unilateral vocal cord paralysis?

? is the second MC cause?

If no SurgHx, what is the next step

A

Iatrogenic

Idiopathic

Normal CN exam- CT w/ contrast
Abnormal CN exam- MRI

284
Q

Unilateral recurrent nerve injury causes the affected vocal cord to assume ? position?

What causes vocal cord dysfunction/paradoxical vocal fold movement?

A

Paramedian- partially lateralized

Upper airway obstruction from paradoxical cord adduction

285
Q

PTs w/ Vocal Cord Dysfunction have a 40% chance of having ? Dx too

How is this condition Dx

A

Asthma non-responsive to bronchodilators

Direct visualization showing adduction w/ both ex/inspiration

286
Q

How is Vocal Cord Dysfunction Tx

An enlarged lymph node is any node larger than ?

A

Speech therapy- 1st line Tx
Stop any steroids
Acute Tx: CPAP and breathing exercises

> 1cm

287
Q

What is the Neck Mass Rule of 7s?

How does this rule apply w/ age considered?

A

Days- inflammatory. rapid growth/pain
Weeks-Months- neoplasm, slow growth/painless
Years- congenital

<16: inflammatory, congenital
16-40: inflammatory/congenital but malignancy risk begins to increase
>40: Ca MC cause
<30, >70: lymphoma needs to be r/o

288
Q

What are the 3 most significant predictors of a neck mass?

What types of Hx are concerning for possible malignancy

A

PT age
Size
Duration

Smoking
Heavy ETOH
Radiation Tx to neck

289
Q

Define Ludwig Angina

This Dx is the MC ?

Why does this become a medical emergency?

A

Bilateral infection of submandibular space (submylohyoid + sublingual spaces)

Neck space infection

Tongue pushed up/back

290
Q

? is the MC cause of deep neck abscesses?

Define Lemierre Syndrome

A

Odotogenic infection

Thrombophlebitis of internal jugular vein secondary to oropharyngeal inflammation

291
Q

Lemierre Syndrome is typically seen in ? PT populations?

What are the S/Sxs of this Dx

A

ICU w/ prolonged internal jugular catheters

Severe HA
Pulmonary infiltrates

292
Q

PTs w/ recurrent deep neck infections need to have ? Dx r/o

Deep neck infections w/ suppurative lymphadenopathy in middle age PTs w/ ? Hx are suspected ? Ca

A

Congenital lesions- brachial cleft cyst

Tobacco/ETOH
SCC

293
Q

? are the 4 MC microbes causing Ludwigs/Deep neck abscesses?

What type of images are needed?

A

Strep
Staph
Bacteroides
Fusobacterium

CT w/ contrast

294
Q

What ABX are given via IV for the Tx of Ludwigs Angina

If the airway is compromised, ? procedure is needed?

A

PCN + Metronidazole/Clina

External drainage via bilateral submental incisions

295
Q

Lemierre Syndrome is usually due to ? microbe

? ABX is used for Tx

A

Fusobacterium Necrophorum

Metronidazole

296
Q

Define Reactive Cervical Lymphadenopathy

This Dx has ? MC title

What causes this condition

A

Painful enlargement of nodes from infection/inflammation

Neck masses in all age groups

Pharynx/salivary/scalp infection

297
Q

How is Reactive Cervical Lymphadenopathy Tx

What are the 3 indications for FNA

A

Augmentin
Clinda

> 1.5cm w/out infection
Tobacco/ETOH/Ca Hx
Persistent enlargement

298
Q

What are the two etiologies of Reactive Cervical Lymphadenopathy?

A

Tumors- SCC Lymphoma, Metastases

Infection-
Virus
Mycobacteria
Cat Scratch (Bartonella Henselae)

299
Q

What tool is used to measure the severity of sleep apnea?

How is this complaint Dx

A

Epworth Sleepiness Scale: 0-24
>10= abnormal, supports excessive daytime sleepiness complaints

Polysomnography

300
Q

What are the non-surgical methods for Tx of OSA

What are the surgical methods for Tx of OSA

A

CPAP
BiPAP

Radiofrquency thermal fibrosis
UPPP
Craniofacial procedure
Hypoglossal nerve stimulation w/ simulator

301
Q

What are the two primary indications for tracheotomy?

How are foreign bodies in the upper aerodigestive tract Dx and Tx

A

MCC- respiratory failure requiring prolonged mechanical ventilation
Obstruction at/above larynx

Dx: CXR
Tx: bronchoscopy

302
Q

S/Sxs of foreign body in esophagus

How are they Dx

How can this be Tx

A

Drooling w/ pointing to level of obstruction

Radiograph

Observation/endoscopic removal

303
Q

? is the MC congenital mass of the lateral neck

Where does this MC tend to appear in PTs

How are these findings confirmed w/ PE?

A

Branchial Cleft Cyst- remnant of embryological development in the neck during 2-3rd decade

Along SCM
On face near auricle

Not midline, don’t move w/ swallowing

304
Q

What image is used to Dx Brachial Cleft Cysts

What is done for Tx

A

CT

Excision w/ fistula to prevent future infection/Ca
Frozen sections to r/o malignancy

305
Q

? is the MC congenital mass of the central neck

How can this Dx be confirmed w/ PE

A

Thyroglossal Duct Cyst- remnant of embryologic descent of thryoid

<20y/o w/ midline cyst below hyoid; moves w/ swallowing and tongue protrusion

306
Q

How are Thyroglossal Duct Cysts Dx

How are these Tx

What must be done prior to Tx

A

TSH levels; abnromal= thyroid scan w/ CT

Surgical removal of cyst and fistula

Thyroid US to confirm thyroid positioning

307
Q

What is the name of the procedure to remove a thyroglossal duct cyst

How are head and neck Ca exams fully completed

A

Sistrunk procedure- removes duct at base of tongue, cyst and medial segments of hyoid bone

Triple endoscopy:
Direct laryngoscopy
Bronchoscopy
Esophagoscopy

308
Q

What is the next step for head/neck Ca if triple endoscopy fails to show a confirmed Dx

SCC of the head/neck tends to metastasize first to ? part of the body prior to moving to ?

A

MRI/PET and biopsy

First- neck lymph nodes
Then- lung, liver, bone, brain

309
Q

Why do ENTs use rigid endoscopes more often than other specialties

What ages do Non/Hodgkins Lymphoma peak

A

Easier to biopsy

20 and >50

310
Q

What are the 4 types of thyroid Ca

A

Papillary:
Dx: FNA
Tx: surgery then I-131 ablation

Follicular:
Dx: biopsy
Tx: surgery then I-131 ablation

Medullary:
Dx: FNA and
Tx: surgery and poor I-131 uptake

Anaplastic/undifferentiated: most aggressive, poor prognosis
Dx: FNA
Tx: surgery and radiation, poor I-131 uptake

311
Q

What type of thyroid Ca has an association with MEN-2A

A

Medullary

IPAP (212 decks)

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