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Ophthamology/ENT > ENT Treatments > Flashcards

ENT Treatments Flashcards

1
Q

Auricular heamtoma

A

Must treat within 7 days or sooner, Surgical evacuation is best, by ENT.

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2
Q

Auricular frostbite

A

Proper, slow rewarming. Refer to ENT. Do not pop bullae that form.

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3
Q

Cerumen impaction

A

Education of proper cleaning techniques (washcloth around external opening w/o entering canal).
Impaction Tx: detergent eardrops (3% hydrogen peroxide), mechanical removal, suction, or irrigation (do not perform unless certain that TM is intact).

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4
Q

Foreign bodies in auditory canal

A

Remove with loop or hook. Use lidocaine to immobilize insects.

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5
Q

External Otitis

A

Protection of auditory canal from further moisture and mechanical injury.
Tx of Swimmer’s ear: drying agent (50/50 mix of isopropyl alcohol/ white vinegar). See back in 1-2 weeks or PRN.
Tx of infection: acidic otic antibiotics (aminoglycoside or fluoroquinolone containing).
Use drops abundantly.
Tx of MEO: prolonged antipseudomonal antibiotic administration for several mos. Ciproflaxin.

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6
Q

Neoplasia of the Auditory Canal/External Ear

A

Most likley SCC - high 5-yr mortality rate, must be treated with wide surgical excision and radiation therapy.

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7
Q

Eustacian tube dysfunction

A

Systemic and nasal decongestants (pseudoephedrine) and autoinflation techniques (forced exhalation against closed

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8
Q

Serous Otitis Media

A

Short course of oral corticosteroids (prednisone) and/or PO AB (amoxicillin). TM tubes if no relief.

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9
Q

Barotrauma

A

Preventative meds (decongestants), autoinflation techniques, possible myringotomy if pain is severe enough.

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10
Q

Acute Otitis Media

A

Analgesics for otalgia.
Oral AB – amoxicillin + sulfonamide (defer prescribing to children for 48-72hrs).
Myringotomy is indicated with SEVERE otalgia or progression of OM to one of its major complications.

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11
Q

Chronic OM

A

Regular removal of infectious debris, use of earplugs to protect against water exposure, and topical AB drops (ofoxacin/ciprofloxacin + dexamethasone).
Definitive management is surgery in most cases. If mastoid air cells involved – mastoidectomy.

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12
Q

Cholesteatoma

A

Nonsurgical: Ototopical AB and/or steroids
Surgical: removal of cholesteatoma sac and create a dry/safe ear.

High rate of recurrence, annual FU

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13
Q

Mastoiditis

A

IV AB (cefazolin), myringotomy for culture and drainage. Possible mastoidectomy.

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14
Q

Facial paralysis due to either COM or AOM

A

AOM – Myringotomy, IV AB.

COM – surgical correction of underlying disease

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15
Q

Otosclerosis

A

Hearing aid use or stapedectomy.

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16
Q

Tinnitus

A

Audiometry to rule out sensorineural hearing loss.

Oral antidepressants have been shown to help.

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17
Q

Acute Labrynthitis

A

Treat sxs – antiemetic (Compazine) and vestibular suppressant (meclizine). AB if suspected bacterial infection.

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18
Q

Vestibular Neuritis

A

antiemetic and vestibular suppressant (meclizine)

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19
Q

Benign Paroxysmal Positional Vertigo (BPPV)

A

usually self-limited, treat sxs (meclizine)

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20
Q

Meinere’s Disease

A

Usually self-limited. Treat sxs

Antiemetic, vestibular suppressant (can you guess?), diuretics, and decreased sodium intake. Yes. It’s meclizine.

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21
Q

Acoustic Neuroma (Vestibular Schwannoma)

A

MRI to confirm. Surgery or radiotherapy.

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22
Q

Vascular Compromise of Vestibulocochlear system

A

Empiric tx is vasodilators and aspirin.

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23
Q

Acute Viral Rhinosinusitis

A

Buffered hypertonic saline nasal irrigation. Possibly Zinc supplementation. PO anticongestants. Nasal sprays, but only in short courses to avoid rebound congestion and subsequent addiction.

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24
Q

Acute Bacterial Rhinosinusitis (Sinusitis)

A

NSAIDS. Oral or nasal decongestants (oral pseudoephedrine). Intranasal corticosteroids for pain/pressure. Only 5% of patients will note a shorter duration of sxs with systemic AB. Use AB when sxs persist for longer than 10 days or are severe.

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25
Q

Nasal Vestibulitis & S aureus Nasal Colonization

A

Systemic AB + topical AB (mupirocin or bacitracin). If, recurrent add rifampin to rid S. aureas carrier-state.

26
Q

Invasive fungal sinusitis

A

Wide surgical debridement. IV amphotericin B. High mortality rate in patients who are severely immunocompromised.

27
Q

Allergic Rhinitis

A

Intranasal corticosteroids sprays, may take 2 weeks for onset of sx relief. May also shrink hypertrophic nasal mucosa. Beclomethasone, flunisolide, mometasone furoate, and fluticasone propionate.

Antihistamines – temporary but immediate relief

Intranasal anticholinergic agents for pts with major rhinorrhea. Ipratropium especially helpful with vasomotor rhinitis.

28
Q

Olfactory Dysfunction

A

Hyposmia secondary to obstructions – surgery.

Special spices and taste enhancers.

29
Q

Epistaxis

A

Direct pressure on bleeding site for 15 minutes. If inadequate, topical sympathomimetics and various nasal tamponade methods (cauterization with silver nitrate, nasal packing). In emergent situations external carotid ligation.

Posterior, bilateral, or large-volume epistaxis should be triaged immediately to a specialist.

30
Q

Oral Candidiasis

A

Antifungal therapy – fluconazole, ketoconazole…

31
Q

Pharyngitis & Tonsillitis

A

Oral Ab based on causative agent. If mono is suspected do not give Amoxicillin (will cause a rash). Salt-water gargles

32
Q

Peritonsillar Abscess & Cellulitis

A

Parenteral amoxicillin or clindamycin. Systemic AB over days. Possible indication of I&D or tonsillectomy.

33
Q

Sialadenitis

A

IV AB, nafcillin, hydration, warm compresses, lemon drops, and gland massages.

34
Q

Sialolithiasis

A

Incision or manipulation/dilation of gland to remove the stone. Must block the duct posteriorly to the stone to prevent it moving back.

35
Q

Dysphonia, hoarseness & stridor

A

Hoarseness for >2weeks - refer

ANY case of stridor –> specialist, rapid onset stridor –> emergency

36
Q

Acute laryngitis

A

Avoid vigorous use of voice. May damage vocal cords. PO or IM corticosteroids in cases of professionals who need their voice.

37
Q

Laryngopharyngeal reflux

A

Proton pump inhibitor, failure may indicate other etiologies

38
Q

Recurrent Respiratory Papillomatosis

A

Repeated laser vaporizations or cold knife resection.

Other tx: Cidofovir, and HPV vaccine (Gardasil)

39
Q

Epiglotittis

A

Hospitalization - IV AB (ceftizoxime and dexamethasone). Tapering coritcosteroids.

Monitor airway for indications of necessary intubation.

40
Q

Vocal fold nodules

A

Modification of voice habits, referral to speech therapist. Recalcitrant nodules may require surgical excision.

41
Q

Vocal fold polyps

A

may resolve after resolution of hemorrhage, larger polyps may indicate surgery

42
Q

Polypoid corditis

A

cessation of smoking. Surgery to open airway/improve voice

43
Q

Contact ulcers & granulomas

A

inhaled corticosteroids, and proton pump inhibitors

44
Q

What does Ipratropium treat?

A

Vasomotor Rhinitis

45
Q

Laryngeal Leukoplakia

A

Direct laryngoscopy with biopsy. Cessation of smoking may reverse or stabilize mild-mod dysplasia.

46
Q

SCC of Larynx

A

Refer immediately.

Four goal tx: Cure, preservation of safe & effective swallowing, preservation of useful voice, and avoidance of permanent tracheostoma.

47
Q

Vocal Fold Paralysis

A

Acute onset of stridor should be referred immediately to a specialist.

48
Q

Foreign bodies in trachea and bronchi

A

Removed under general anesthesia. Heimlich for immediate removal, cricothyrotomy may be necessary.

49
Q

Esophageal foreign body

A

Depends on severity and nature of foreign body swallowed. Hospitalization with monitoring, barium swallow, or esophagoscopy.

50
Q

Branchial cleft cysts

A

Complete excision

51
Q

Thyroglossal Duct Cysts

A

Complete excision

52
Q

Tuberculous & Nontuberculous Mycobacterial Lymphadenopathy

A

FNA biopsy with cytology, acid-fast smear, culture, and sensitivity test.

Tuberculous lymphadenopathy (diff chapter so who cares).

Oral AB based on sensitivity results.

53
Q

Trigeminal Neuralgia

A

DDx: Young patient - MS even without other nuerological signs

Posterior fossa tumor (CT and MRI imaging)

Tx: Oxcarbazepine, carbamazepine, with monitoring by serial blood counts and liver function tests. Gabapentin may also relieve pain.

For neuralgia due to vascular impingement –> surgical decompression

54
Q

Atypical facial pain

A

Simple analgesics first. Tricyclic antidepressants (carbamazepine, oxcarbazepine, and phenytoin).

55
Q

Glossopharyngeal Neuralgia

A

Oxcarbazepine and carbamazepine tried before surgery considered.

56
Q

Postherpetic neuralgia

A

If simple analgesics fail, trial of tricyclic antidepressants (amitriptyline, or nortriptyline). A combo of gabapentin and morphine may be tried. Topical lidocaine.

57
Q

Mucocele

A

Drainage & excision necessary.

58
Q

Ranula

A

I&D

59
Q

Infectious mononucleolisis

A

Self-limiting. Treatment involves rest, fluids, and over-the-counter pain and fever-reducing medicines to ease symptoms.

60
Q

Angular Cheilitis

A

Restore height and use antifungals

61
Q

Ludwig’s Angina

A

Manage airway, may require I&D.

62
Q

Reactive Lymphadenitis

A

May resolve without tx. Viral is self-limited. Needs close attention.
In general: treat with 10-14 day course of AB, follow-up is very important (2-3 weeks).
If not resolved, need further work-up.

Ophthamology/ENT (2 decks)

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