Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Adult/Ped Medicine Cumulative Final > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Obstructive Lung Diseases (3)

A
  1. Asthma
  2. Chronic Bronchitis
  3. COPD (emphysema)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Characterisitics of COPD

A
  • chronic airway obstruction
  • airflow limitation
  • generally progressive over time
  • may have airway hyperactivity (reversible component)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

define Emphysema

A

a pathologic diagnosis based on a permanent abnormal dilation and destruction of the alveolar ducts and air spaces distal to the terminal bronchioles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

define Chronic Bronchitis

A

a clinical diagnosis based on the presence of a cough and sputum production occurring on most days for at least a 3-month period during 2 consecutive years without another explanation. Cough is not necessarily accompanied by airflow limitation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Identify this condition and describe the management:

cc: shortness of breath while exercising
exam: pt is thin, breathing through pursed lips and using accessory muscles, and has no cough or sputum production

x-ray:

A

Emphysema - Pink Puffer

managment:

  • stop smoking
  • inhaled beta-2 agonists (Albuterol); anticholinergic (Ipratropium)
  • inhaled/oral corticosteroids
  • theophylline
  • oxygen therapy (end-stage)
  • antibiotics
  • influenza and pneumococcal vaccines

on x-ray note: hyperinflation, hyperlucency, increased retrosternal air space, flat diaphragm, small heart, bullae formation

pt will also have decreased P02 and normal or decreased PCO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Identify this condition and describe the management:

cc: coughing up phlegm and shortness of breath while exercising and just sitting at home
exam: you note the pt is obese

x-ray:

A

Chronic Bronchitis (ain’t no body got time for that) - Blue Bloater

managment:

  • stop smoking
  • inhaled beta-2 agonists (Albuterol); anticholinergic (Ipratropium)
  • inhaled/oral corticosteroids
  • theophylline
  • oxygen therapy (end-stage)
  • antibiotics
  • influenza and pneumococcal vaccines

x-ray findings: normal or incrased lung markings, cardiomegaly, pulmonary HTN, cor pulmonale

pt will have reduced PO2 and elevated PCO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Identify this condition:

pt is a 25 year old non smoker complaining of shortness of breath on exertion

CXR shows a panacinar distribution of emphysema

A

Alpha-1-antitrypsin deficiency

management: replace alpha-1-antitrypsin, eliminate exacerbating factors, COPD management (fpnotebook.com)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Stage 1 Mild COPD

A

FEV1/FVC < 70%

FEV1 > 80% predicted

with or without chronic symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Stage 2 Moderate COPD

A

FEV1/FVC < 70%

30 < FEV1

with or without chronic symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Stage 3 Severe COPD

A

FEV1/FVC < 70%

FEV1 < 30% predicted or < 50% predicted plus respiratory failure or clinical signs of right heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Identify this condition and describe the managment:

pt: reports shortness of breath on exertion, chronic wet cough
exam: little or no sputum production, elevated jugular venous pressure and hepatomegaly

CXR: enlarged RV and PA

A

Cor Pulmonale

RV hypertrophy and eventual failure

results from pulmonary disease: hypoxia, pulmonary vascular disease, COPD

diagnosis:

ECHO excludes LV dysfunction

ECG changes: RVH, tall peaked P waves, right axis deviation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Chantix (varenicline)

A

targets the same receptors as nicotine and blocks nicotine from binding

helps reduce the urge to smoke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Clinical Strategies for Smoking Cessation (5 A’s)

A

ASK - identify smokers at each visit

ADVISE - urge smokers to quit

ASSESS - readiness to make an attempt to quit

ASSIST - counseling and meds

ARRANGE - schedule follow-up contact

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Asthma Symptoms

A
  • Cough - with or without expectoration of excessive mucus
    • Hemoptysis - part of Churg-Strauss vasculitis or allergic bronchopulmonary aspergillosis
  • Shortness of breath
  • Wheeze
  • Chest tightness or pain
  • Hyperventilation Syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Asthma Control: Medications

A

follow-up every 1-6 months to make sure control is being maintained - use the lowest effective dose

Long-term control - medication taken daily to achieve and maintain control

  • corticosteroids
  • cromolyn sodium and nedocromil
  • long acting beta-2-agonists
  • leukotriene modulators

Quick-relief - medications taken to provide prompt relief

  • short acting beta-2-agonists
  • anticholinergics
  • systemic corticosteroids

Complementary Alternative Medicine

  • epinephrine
  • ephedra
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Asthma Exam Findings

A
  • wheezing (cannot be used as a predictor of severity of airflow obstruction)
  • use of accessory muscles of breathing - inspiration
  • eczema, atopic dermatitis or other types of allergic skin disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Asthma History

A
  • history of intermittent, seasonal waxing/waning of symptoms
  • noctural episodes
  • exacerbation of symptoms on exposure to:
    • exercise
    • excitement
    • stress
    • cold air
    • aeroallergens (pollen, mold, animal dander)
    • URI
    • strong odors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Pathophysiology of Asthma

A

smooth muscle dysfunction

airway inflmmation

airway remodeling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Differential Diagnosis of Cough - Adults

A
  • COPD
  • Heart Failure
  • PE
  • Laryngeal dysfunction
  • Tumor
  • Pulmonary infiltration with eosinophilia
  • Secondary to drugs
  • Vocal cord dysfunction
  • GERD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Differential Diagnosis of Cough - Children

A
  • allergic, rhinitis and sinusitis
  • foreign body in trachea or bronchus
  • vocal cord dysfunction
  • vascular rings or laryngeal webs
  • enlarged lymph nodes or tumor
  • cystic fibrosis
  • heart disease
  • GERD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Asthma Control Components (4)

A
  • assessment and monitoring
  • education for parternship in care
  • control of environmental factors and comorbid conditions
  • medications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Diagnosis of Asthma

A

Spirometry

FEV1 is the most important variable - declines in direct/linear proportion with obstruction; increases after successful treatment

FEV1/FVC ratio > 75 is normal

Histamine/methacholine challenge - increase dose until FEV drops 20%

Short acting bronchodilator - increase FEV >12% of 200 mL - significant reversibility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Definition of Asthma

A

chronic inflammation disorder

airflow obstruction

severe narrowing of the airways

wheezing, coughing, breathlessness, chest tightness

reversible

recurrent episodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Risk Factors of Death from Asthma

A
  • past hx of sudden severe exacerbations
  • prior intubations for asthma
  • admission to ICU for asthma
  • 2+ hospitalizations for asthma
  • 3+ ER visits for asthma
  • low socioeconomic status
  • >2 canisters/month of inhaled short acting beta-agonist
  • current use of systemic corticosteroids
  • difficulty perceiving airflow obstruction
  • illicit drug use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Asthma Assessment Measures

A

Spirometry

  • initially
  • after treament and symptoms have stabilized
  • every 1-2 years - assess maintenance of airway function

Peak-Flow Monitoring

  • short-term monitoring management of exacerbations
  • daily long-term monitoring
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Asthma Pathophysiology - Smooth Muscle Dysfunction

A

exaggerated contraction

increased smooth muscle mass

increased release of inflammatory mediators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Asthma Control: Control Other Factors

A
  • environmental factors allergens and irritants
  • comorbid conditions - maximize treatment of other conditions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Asthma Control: Assessment & Monitoring

A

Severity - intrinsic intensity of the disease process; assessed in patient not receiving long-term control

Control - degree to which the manifestations of asthma are minimized by therapy

Responsiveness - ease with which asthma control is achieved by therapy

Impairment - symptoms, lung function by spirometry

**Risk of Adverse Events **

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Asthma Pathophysiology - Inflammatory Response

A

Acute Respone

  • bronchial hyperreactivity
  • mucosal edema
  • airway secretions

Chronic Response

  • increased inflammatory cell numbers
  • epithelial damage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Triad of Asthma Symptoms

A
  1. Cough
  2. Shortness of breath
  3. Wheeze

patients may present with only one of these symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Asthma Pathophysiology - Airway Remodeling

A

cellular proliferation - smooth muscle cells, mucous glands

increased matrix protein deposition

basement membrane thickening

angiogenesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Risk Factors for Asthma

A
  • production of abnormal amounts of IGE
  • gender male (10 or less)
  • atopy
  • family history
  • wheezing on expiration
  • low income populations
  • minorities
  • children living in inner cities
  • peak expiratory flow that varies 20% or more between morning and afternoon
  • obesity
  • worsening of symptoms in presence of allergens
  • worse symptoms at night
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Asthma Control: Education

A

patient develops self-managment of their asthma

action plans

patient education

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Characteristic Radiographic Appearance of Right-Sided Endocarditis

A

focal embolic lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Etiology of Community Acquried Pneumonia

Bird, Tick, Rodent Exposure; Rancher

A

Bird Exposure: Psittacosis, Histoplasmosis

Rancher: Q-fever, Brucellosis

Tick Exposure/Hunter: Tularemia

Rodent Exposure: sin nombre virus (hanta virus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Characteristic Radiographic Appearance of Aspiration

A

superior segment of right middle lobe

or

posterior segment of right upper lobe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Outpatient Management of Community Acquired Pneumonia

A

Previously Healthy: macrolide or doxycycline

Comorbidities: respiratory fluoroquinolone or ß-lactam + macrolide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Urinary Antigen Detection

A

Pneumococcal Ag: rapid, simple, not affected by antibiotic administration, may stay positive for 2-3 months

Legionella Ag: detects serogroup 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Characteristic Radiographic Appearance of Bacterial Pneumonia

A

Lobar of segmental consolidation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Community Acquired Pneumonia - Discharge Criteria

A

no more than 1 during prior 24 hours (unless it is a baseline status):

Temperature > 37.8 C

Pulse > 100 beats/min

Respiration > 24 breaths/min

Systolic blood pressure < 90 mm Hg

Blood O2 saturation < 90%

Inability to maintain oral intake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Characteristic Radiographic Appearance of Pneumonia - “atypical” pathogen

A

Diffuse or patchy interstitial pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Characteristic Radiographic Appearance of Tuberculosis

A

apical infiltrates, cavitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Etiology of Community Acquried Pneumonia

CF/Bronchiectasis, COPD, Influenza, Cough > 2-3 Weeks

A

CF/Bronchiectasis: Pseudomonas, Burkholderia, S. aureus

COPD: H. influenzae, M. catarrhalis

Influenza: S. aureus, infleunza

Cough > 2-3 weeks: Pertussis, TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Prevention of Community Acquired Pneumonia

A

Get flu vaccine

Pneumococcal vaccine

Covering coughs

Hand washing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Etiology of Community Acquired Pneumonia

Splenectomy, HIV, IV Drug Abuse, Alcoholism

A

Splenectomy: encapsulate organisms - H. influenzae, Pneumococcus

HIV: Pneumococcus, PCP, TB

IV Drug Abuse: right sided endocarditis (S. aureus)

Alchoholism: Pneumococcus, Klebsiella or other g(-) bacilli aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Community Acquired Pneumonia - Duration of Therapy

A

treat for a minimum of 5 days

should be afebrile for 48-72 hours

should have no more than 1 CAP associated sign of clinical instability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Criteria for ICU Admissions for Community Acquired Pneumonia

Major Criteria & Minor Criteria

A

admit to ICU with 1 major or 3 minor

Major Criteria:

  • need for mechanical ventilation or pressors

Minor Criteria:

  • Respiratory rate > 30/min
  • PaO2/FIO2 < 250
  • Multilobar infiltrates
  • Altered mental status
  • Uremia (BUN > 20)
  • Leukopenia (
  • Thrombocytopenia (
  • Hypothermia (
  • Hypotension requiring fluid resuscitation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Etiology of Community Acquried Pneumonia

Travel, Hotel/Cruise Ship

A

Travel: Coccidioidmycosis, Histoplasmosis, Melioidosis

Hotel/Cruise Ship: Legionella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Inpatient Management of Community Acquired Pneumonia

A

Medical Ward: respiratory fluroquinolone or ß lactam

ICU: ß-lactam + either azithromycin or a respiratory fluoroquinolone

Special Concerns - could probably look this up in Sanford : )

Pseudomonas: antipneumococcal, antipseudomonal ß-lactam + cipfrofloxacin or levofloxacin ORa ntipneumococcal, antipseudomonal ß-lactam + aminoglycoside and azithromycin

Psedomonas and Penicillin Allergy: aztreonam

CA-MRSA: add linezolid or vancomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Sputum Examination in Community Acquired Pneumonia

A

specimen should be from deep cough, purulent

immediately transported to laboratory

examine under microscope - report semiquantitatively

performed to optimize antibiotic selection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

CURB-65 Scoring System

A

C - confusion

U - BUN level > 7 mmol/L

R - respiratory rate > 30 breaths/min

B - low blood pressure (systolic < 90 mmHg or diastolic < 60 mmHg)

65 - greater risk if over 65 years of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Cystic Fibrosis - Sweat Chloride Test Results

> 6 months of age

A

Recommendations > 6 months of age:

Normal < 39 mmol/L

Intermediate 40-59 mmol/L

Abnormal > 60 mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Manifestations of Cystic Fibrosis

Lungs

A
  • Bronchiectasis
  • Bronchitis
  • Bronchiolitis
  • Pneumonia
  • Atelectasis
  • Hemoptysis
  • Pneumothorax
  • Reactive airway disease
  • Cor pulmonale
  • Respiratory failure
  • Muccoid impaction of the bronchi
  • Allergic bronchopulomonary aspergillosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Pathogenesis of Lung Disease in Cystic Fibrosis

A

Abnormal CFTR gene →

Abnormal CFTR protein →

Abnormal Salt Transport →

Abnormal Mucus →

Impaired Clearance →

Pseudomonas Infection →

Inflammatory Response →

Bronchiectasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

CFTR-Related Metabolic Syndrome (CRMS)

A

infants indentified by:

  • hypertypsinogenemia on Newborn Screening
  • sweat chloride
  • up to 2 CFTR mutations, 1 of which is not clearly recognized as a CF causing mutation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Cystic Fibrosis - Sweat Chloride Test

< 6 months of age

A

Recommendations < 6 months of age:

CF unlikely < 29 mmol/L

Intermediate 30-59 mmol/L

CF likely > 60 mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Manifestations of Cystic Fibrosis

A

Spleen: hypersplenism

Stomach: GERD

Pancreas: pancreatitis, insulin deficiency, symptomatic hyperglycemia, diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Manifestations of Cystic Fibrosis

General

Nose and Sinuses

Bones

A

General: growth failure, vitamin A, D, E, K deficiency

Nose/Sinuses: nasal polyps, sinusitis

Bones: hypertrophic osteoarthropathy, clubbing, arthritis, osteoporsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Manifestations of Cystic Fibrosis

Heart

Reproductive System

A

Heart: right ventricular hypertrophy, pulmonary artery dilation

Reproductive: infertility, amenorrhea, delayed puberty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Manifestations of Cystic Fibrosis

Intestines

A
  • meconium ileus
  • meconium peritonitis
  • rectal prolapse
  • intussusception
  • volvulus
  • fibrosis colonopathy (strictures)
  • appendicitis
  • intestinal atresia
  • distal intestinal obstruction syndrome
  • inguinal hernia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

How is Cystic Fibrosis diagnosed?

A

Newborn screening test: test IRT/DNA or IRT/IRT if positive parents and PCP are notified

at the CF Center: sweat chloride test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Manifestations of Cystic Fibrosis

Liver

Gallbladder

A

Liver: hepatic steatosis, portal hypertension

Gallbladder: biliary cirrhosis, neonatal obstructive jaundice, cholelithiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Genetics of Cystic Fibrosis

A

autosomal recessive disease

most common genotype: deltaF508/deltaF508

1000+ mutations; most common - ΔF508

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Vicious Cycle of Cystic Fibrosis Lung Disease & Treatments for Each Stage

A

Inflammation: ibuprofen, corticosteroids, leukotriene modifiers

Infection: tobramycin, azithromycin

Obstruction: airway clearance, dornase alfa, hypertonic saline, bronchodilators (albuterol; xopenex), chest percussion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Common Infections Affecting CF Patients

A

Viral: RSV

Bacterial: Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Achromobacter xylosoxidans, Brukholderia cepacia, Staphylococcus aureus

Mycobacterial: M chelonae/abscessus, m avium intraceullare

Fungal: Aspergillus fumigatus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Cystic Fibrosis Routine Screenings

A

Newborn Period - checkups every 4-6 weeks + normal PCP visits

After 1st year of life -

Every 3 months

  • Pulmonary Function Tests
  • Sputum Culture
  • Social Worker and Dietition as needed

Annually -

  • CBC, CRP, Chem 14, Vitamin Levels, IgE
  • Chest X-Ray
  • Evaluation by Social Work and Dietitian
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

CFTR-Related Metabolic Syndrome (CRMS) - Concerning Symtpoms

A

lack of weight gain or unresolved acute weight loss

persistent loose stools and excessive flatus

abdominal pain

coughing or wheezing - contact CF specialist if longer than 2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Identify this condition and describe the management:

pt (4 yo) presents with a lesions on the attached gingiva and moveable mucosa

exam: irritable, anorexia, anterior cervical lymphadenopathy, fever (103-105)

A

Primary Herpetic Gingivostomatitis (children)

typically occurs 6 months to 5 years

MAY BE ASYMPTOMATIC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Primary Herpetic Infections Adult

A

presents as pharyngotonsillitis

watch for vessicles on tonsillar pillar

clinically similar to bacterial tonsillitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Identify this condition and describe the managment:

pt presents with multiple vesicles containing clear fluid on her lower lip, she noted that the area felt tingly the day before

A

Recurrent Oral Herpes (Cold Sores)

prodromal stage: 12 hours-2 days prior to outbreak

vesicels crust over in approximately 1 week, total healing 2 weeks

subsequent eruptions triggered by: stress (UV light, malnutrition, trauma, immunological issues)

TX: Pencyclovir (Cream), Valacyclovir (capusles) - taken at the onset of the prodromal stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Identify this condition and describe the management:

pt presents with 2 lesions approximately 5 mm in size on the non-keratizined tissues of his mouth, the lesions are ulcerated, erythematous macules with a red halo and very painful

A

Minor Apthous Stomatitis (Canker Sore)

immunologic cause - minor trauma + trigger

80% of all apthous stomatitis

heals over without scars in 7-10 days

tx: topical corticosteroids (triamcinolone acetonide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Identify this condition and describe the management:

pt presents with a painful 3 cm lesion on the labial mucosa

A

Major Apthous Stomatitis

10% of Apthous Stomatitis

cause: immunolgic

other sites: posterior oral cavity, soft palate, tonsillar fauces

heals with scarring in 2-6 weeks

tx: topical corticosteroid (triamcinolone acetonide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Identify this condition and describe the management:

pt presents with numerous lesions (2 mm in size) across the entire mucosal surface

A

** Herpetiform Apthous Stomatitis**

greatest number of lesions (up to 100), most frequent recurrences

predominantely nonkeratinized tissue but can occur on any oral mucosal surface

form of erythema multiforme

tx: topical corticosteroid (triamcinolone acetonide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Identify this condition and describe the management:

pt presents with white, cottage cheese like plaque on his tongue and a “bad taste” in his mouth

exam: the plaque could be wiped away with a tongue blade

A

Candidiasis (aka trush)

most common oral fungal infection

caused by Candida Albicans

predisposing factors: diabetes mellitus, steroids, broad-spectrum antibiotics, dentures, iron-deficiency, immunocompromised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Identify this condition:

pt reports that his mouth feels “like it was scalded”, he was on penicillin a week ago for strep throat

A

Acute Atrophic Candidiasis

antibiotic sore mouth

tx: clotrimazole (troche), Nystatin (ointment)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Identify this condition:

pt presents with an erythematous, sharply circumscribed, asymptomatic, plaque-like lesion on the dorsal midline of the tongue

A

Median Rhomboid Glossitis

tx: clotrimazole (troche), Nystatin (ointment)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Identify this condition:

pt presents with erythema, fissuring and scaling of the corners of the mouth

A

Angular Cheilitis

causes: C. Albicans, Mixed, Staph aureus

combined with old, worn dentures and collapsed bite

tx: clotrimazole (troche), Nystatin (ointment)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Identify this condition:

pt is an 80 year old female, presents with asymptomatic, red, irritated tissue below where her dentures are placed

A

Denture Stomatitis

aka Chronic Atrophic Candidiasis

tx: clotrimazole (troche), Nystatin (ointment)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

define Leukoplakia

A

not a disease but a clinical term

white patch or plaque that cannot be attributed to any other disease

pre-malignant lesion (4% lifetime risk of malignant transformation

risk of lesion increases with age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

etiology of Leukoplakia

A

tobacco: (80% of smokers)
alcohol: synergistic effect with tobacco

UV: low lip vermillion

microbes: C. albicans and HPV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

define Erythroleukoplakia

A

speckled leukoplakia

red and white mixed colored lesion

28% transformation to malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

define Erythroplakia

A

pre-malignant lesion

50% are already invasive carcinoma by time of biopsy

typically found of floor of mouth, tongue and soft palate (all high risk locations)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What are the 4 clinical variants of oral Squamous Cell Carcinoma?

A

leukoplakia (erythroleukoplakia)

erythroplakia

exophytic (mass-forming)

endophytic (ulcerating)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Oral Squamous Cell Carcinoma

A

90% of oral malignancies

far more deadly than SCC of skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Tooth Anatomy - Cliff’s Note’s Edition

A

Enamel - hard outer covering, brittle, thin

Dentin - has dentinal tubules and odontoblastic processes, continues to form throughout life

Cementum - covers only the root has Sharpey’s fibers in it

Peridontal Ligament - attach tooth, cushion force, made of collagen-rich Sharpey’s fibers

Dental Pulp - contains blood vessels, lymphatic vessels, myelenated and unmyelanated nerve fibers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Primary Dentition

(baby teeth)

A

20 teeth - 10 in each arch

4 incisors, 2 canines, 4 molars

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Adult Dentition

A

32 teeth total, 16 per arch

each arch: 4 incisors, 2 canines, 2 pre-molars, 3 molars

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Eruption Milestones:

age 1st tooth appears:

completion of primary dentition:

age 1st permanent tooth appears:

completion of permanent dentition:

A

Eruption Milestones:

1st tooth: roughly 6 months (mandibular, central)

completion of primary dentition: 2-2.5 years

1st permanent tooth: 6 years (mandibular 1st molar)

completion of permanent dentition: 12-13 years (no 3rd molars)

*from ages 8-10 “classic mixed dentition” 1/2 primary, 1/2 permanent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Identify the condition and describe the management:

pt is a newborn presenting for a 2 week check up

exam: you note 2 teeth, and ulceration of the lower lip

A

Neonatal Teeth ->

Riga Fede Disease (ulceration)

seen at birth or within 30 days

prematurely erupted portion of deciduous dentition can interfere with nursing

tx: if supernumerary remove the tooth, if not smoother it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Hyperdontia

Supernumerary Teeth

A

extra tooth in addtion to the 20 primary or 32 permanent teeth

can impede eruption of other teeth

most common:

  • anterior maxillary incisor region
  • 4th molar
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Hypodontia

A

Congenitally Missing Teeth - alveolar housing is deficient locally

more common in females

multiple missing teeth can be a component of several syndromes

most likely

  1. 3rd molar
  2. lateral incisior
  3. 2nd premolar
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Identify this condition and describe the management:

pt is a 7 year old and is pretty pumped to be getting his adult teeth and money from the tooth fairy

mom however is worried about this vesicle that has appeared:

A

Eruption Cyst

  • remnant of developmental dental follicle
  • occurs after the erupting tooth has emerged through bone

tx: once the tooth penetrates the gingiva, cyst drains and heals uneventfully - may require enucleation

Eruption Hematoma

blood filled cyst (see below)

tx: same

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Enameloblast Insult

A

causes: fever, medications (TETRACYCLINES), trauma

imperfect enamel “hypoplastic” can be localized or generalized

active: 14 weeks I.U. to approx 8 (2nd molars), 14 (3rd molars)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Describe the dentition changes that can occur from thumb sucking and pacifiers.

A

anterior maxillary teeth flare outward & mandibular retroclination - open bite

if it continues past eruption of permanent teeth, may permanently change skeletal form of anterior maxilla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What is tooth decay?

A

demineralization of tooth structure by lactic acid

dental plaque: biofilm of bacteria, proteins, and glycoproteins

normal flora: streptococcus mutans and lactobacillus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Baby Bottle Decay

Early Childhood Caries

A

typically seen 1-3 year olds

due to having control of drinks throughout day and or night - bottle at bedtime, sippy cups - child holding fluid for extended period of time against teeth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Differentiate between:

Pit and Fissure Decay

&

Smooth Surface Decay

A

Pit and Fissure Decay -

  • pits and fissures can be too narrow for toothbrush bristles to clean
  • usually develops 0-3 years after eruption of tooth

Smooth Surface Decay

  • between teeth (interproximal surfaces) or near gingival margin on the buccal surface
  • 2-5 years after eruption of tooth
98
Q

Gingivitis

A

marginal gingiva swells due to irritation from normal flora bacteria in dental plaque and calculus

REVERSIBLE but can progress to periodontitis

increased probing depth in gingival sulcus

99
Q

Periodontitis

A

begins as gingivitis

deepest part of gingival sulcus has less oxygen and nutrients

anaerobic bacteria: Actinobacillus actinmycetemcomitans; Porphymonas gingivalis, Bacteroides forsythus - produce* *collagenase

collagenase: breaks down peridontal ligament

affects hard and soft tissue

without treatment: tooth loss

100
Q

Describe the managment and complications of tooth displacement:

A

damage to peridontal ligament - stabilization for 2 weeks

if pulpal tissues damaged or severed: root canal

time out of correct position is critical, if more than 2 hours reimplantation will fail

can have resorption

  • external destroy tooth from PDL
  • internal destroy tooth from nerve chamber
101
Q

Dentoalveolar Fracture

A

requires replacement and stabilization for 2-8 weeks

pulpal tissue damages requries treatment (root canal)

102
Q

Dental Trauma Management:

if the tooth is chipped and patient has no pain, blood, mobility

A

no hurry

103
Q

Dental Trauma Management:

if tooth is fractured with sensitivity

A

go to dentist

104
Q

Dental Trauma Management:

if tooth avulsed

A

replace the tooth NOW and refer to dentist ASAP

105
Q

Identify the condition and describe the management:

pt is a rugby player and recieved a blow to the ear, he has an accumulation of blood in the subperichondrial space

A

Auricular Hematoma -

aka cauliflower ear

complications: cartilaginous necrosis, permanent disfigurment
tx: within 7 days, surgical evacuation refer to ENT

106
Q

Identify the condition and describe the management:

pt’s ear appears pale and cyanotic

pt was sledding with some friends and didn’t wear a hat

upon rewarming pt reports pain; erythema and blisters are noted

A

Auricular Frostbite

due to prolonged exposure to cold, vasoconstriction, dehydration and freezing of auricular tissue

early on reversible, increased time necorsis results

tx: rapid rewarming, refer to ENT

107
Q

Identify the condition and describe the management:

pt complains of otalagia, aural fullness, pruritus and tenderness upon palpation

otoscopic exam shows:

A

Otitis Externa

Staph aureus and Pseudomonas aeruginosa

pathogenesis: heat, humidity, maceration result in edema and occlusion of apopliosebaceous units

other findings: can also have otorrhea and occlusion of EAC

management:

  1. clean EAC - irrigation, enhances drop penetration
  2. treat inflamamtion and infection -
  • acidifying agents, antiseptics, topical steroids and antibiotics (Cipro HC, Corticosporin, Tobrdex, Pred-G)
  • systemic antibiotics - quinolones
  1. control pain - oral analgesics, oral anti-inflammatories
  2. culture in severe cases
  3. avoid promoting factors
    * keep ear dry during recovery

follow up: 1-2 weeks, should improve 36-48 hours

108
Q

Describe the causes, managment, and complications of a perforated Tympanic Membrane.

A

Causes:

  • trauma
  • barotrauma
  • AOM

Management:

  • protect from moisture
  • small perforations can heal on own
  • surgery for larger perforations

Complications:

  • can have hearing loss depending on the location of perforation
  • cholesteatoma
  • chronic perforation
109
Q

Eustachian Tube Dysfunction

causes, symtpoms, treatment

A

causes:

  • URI
  • allergies
  • inflammatory causes

symptoms:

  • aural fullness
  • fluctuating hearing
  • discomfort

treatment:

  • meds
  • autoinflation techniques
110
Q

Barotrauma

causes, treatment

A

Causes

  • poor eustachain tube function
  • flying, driving, abrupt altitude changes

Treatment

  • preventative medications
  • autoinflation
  • myringotomy
111
Q

Describe the complications of Acute Otitis Media:

A

Extracranial

  • acute mastoiditis
  • labyrinthitis
  • petrositis
  • CN VII paresis or paralysis
  • cholesteatoma
  • perforation & tympanosclerosis

Intracranial

  • meningitis
  • epidural abscess
  • subdural abscess
  • brain abscess
  • otitic hydrochephalus
  • sigmoid sinus thrombosis
112
Q

Identify the condition and describe the management:

pt was seen last week for AOM

pt presents with fever 38 C, postauricular pain and erythema

A

Mastoiditis

cause: inadequately treated otitis

management:

  • CT scan
  • admit and treat aggressively
  • surgery may be required
113
Q

Identify the condition and describe the management:

pt was seen last week for AOM

pt is lethargic, presents with a fever, headache and nausea

ophthalmoscopic examination shows papilledema

A

Sigmoid Sinus Thrombosis

septic thrombophlebitis of sigmoid sinus

diagnosis: MR venography
tx: IV antibiotics, surgical debridement

114
Q

Identify the condition and describe the management:

pt complains of tinnitus, hearing loss and purulent otorrhea

otoscopic exam shows TM retraction with a small perforation, purulent otorrhea, some ossicle erosion

A

Cholesteatoma

pathophysiology: chronic negative middle ear pressure leads to retraction of TM, disrupting migratory pattern of squamous epithelium resulting in the accumulation of keratin debris - cholesteatoma sac

diagnosis: imaging can help but is not definitive

managment:

  • non-surgical: otopical antibiotics/steroids
    • pseudomonas, strep, staph, proteus
  • surgical: removal, high rate of recurrence, yearly follow up
115
Q

Indications for Cerumen Removal

A
  • hearing loss
  • poorly functioning hearing aid
  • ear pain
  • ear fullness
  • unexplained fever
  • unexplained facial paralysis
  • unexplained dizziness
116
Q

Complications of Cerumen Removal

A
  • lacerations
  • further impaction
  • otitis externa
  • perforation
  • pain
  • hearing loss
  • vertigo
117
Q

Nasal and Paranasal Anatomy

A

channel your inner Dr. Keim : ) you know this stuff . . . if you neeed a little review: slides 3-22 serve as a good review

118
Q

Common Patholgoy of the Nasal and Paranasal Sinus

hint: KITTENS

A

K = Congenital

I = Inflammatory, Infectious, Immune, Idiopathic.

T = Trauma, Tumor

T = Toxic

E = Endocrine

N = Neurologic

S = Systemic, Psychogenic

119
Q

Rhinitis vs. Rhinorrhea

A

rhinitis: nasal hyperfunction, tissue inflammation
rhinorrhea: tissue transudate (hypersecretion)

120
Q

Causes of Acute Viral Rhinitis

A

most common cause: Rhinovirus

others: Corona viruses, respiratory syncytial virus (RSV), parainfluenza viruses, Coxsackie virus, adenovirus

121
Q

Acute Viral Rhinitis: Prodromal Stage

A

hours

local invasion and nasal ischemia

hot, tickling sensation

“unusually clear nose”

122
Q

Acute Viral Rhinitis: Catarrhal Stage

A

hours to days

infection spreads over the mucousal surface via lymphatics

sneezing, profuse watery discharge nasal obstruction

mucousal erythema and edema, mild fever

123
Q

Acute Viral Rhinitis: Mucous Stage

A

days

venous stasis/secondary infection

nasal discharge thickness/”mucopurulent”

mucosa becomes dusky

nasal obstruction at its worst

124
Q

Acute Viral Rhinitis: Resolution

A

regression of signs and symptoms within 10 days

125
Q

Identify the condition and describe the managment:

pt reports nasal obstruction, sneezing, head feeling full and itchy eyes and nose, clear nasal discharge

exam: pale-bluish, boggy nasal mucosa, inferior turbinates are swollen

A

Allergic Rhinitis

Type 1 Hypersensitivity reaction: antigen binds to IGE, mediators (histamine) is released producing symptoms

causal tx: avoidance, immunotherapy

symptomatic: antihistamines, steroids, decongestants

126
Q

Identify this condition and describe the management:

pt complains periods of congestion and a runny nose that come on after eating the spicy salsa that Zemogs put on his burrito

exam shows bilateral watery secretion, deep red mucosa and turbinate swelling

A

Vasomotor Rhinitis

idiopathic nasal congestion and rhinorrhea not associated with sneezing or pruritus

triggers: chemical, climatic, and emotional factors

medical tx: steroid, ipratropium bromide

surgical: directed to the inferior turbinate

127
Q

Identify this condition and describe the management:

pt complains of:

facial pain and fulless, sinus pain

nasal blockage, post nasal drainage, mucopurulent smelly discharge

headache and fatigue

exam:

nose: mucous red, edmatous; purulent discharge noted
sinuses: tender to palpation

A

Acute Sinusitis

predisposition: subsequent inflammation, blockage, deviated septum, trauma, excessive dryness, impaired cilia, immunocrompomised states
micrbiology: Strep pneumo, H. flu, Moraxella catarrhalis (rare - Staph aureus, Strep pyogenes)

tx:

  • antibiotics if symptoms persit for 7-10 days
  • decongestant
  • steam, saline, irrigations
  • mucolytic decongestants
  • antihistamines
128
Q

Symptoms of Acute Sinusitis

A

Major Symptoms:

  • facial pain/pressure
  • facial congestion/fullness
  • nasal obstruction/blockage
  • nasal discharge/purulence/discolored postnasal drainage
  • hyposmia/anosmia
  • purulence in nasal cavity
  • fever (acute rhinosinusitis only)

Minor Symptoms

  • headache
  • fever (all non-acute)
  • halitosis
  • fatigue
  • dental pain
  • cough
  • ear pain/pressure/fullnes
129
Q

Identify this condition and describe the management:

pt compalins of nasal obstruction, postnasal drainage and occasional pain/pressure for the past 3.5 months

A

Chronic Sinusitis

microbial causes: anaerobic gram positive cocci, Fusarium species, alpha-strep, H. Flu, Staph a.

tx:

  • antibiotics
  • saline irrigation
  • steroid spray
  • allergen densitization
  • envrionmental controls
  • antihistamines if allergic
  • Functional Endoscopic Sinus Surgery (FESS) to open drainage pathways and aerate the sinuses
130
Q

Chronic Rhinosinusitis Types

A
  • Aspirin Exacerbated Respiratory Disease
  • Allergic Fungal Sinusitis
  • Asthmatic Sinusitis
  • Allergic Sinusitis
  • Cystic Fibrosis
  • Chronic Rhinosinusitis with/without polyposis
  • Chronic Rhinosinusitis with/without biofilm
  • Chronic Eosinophilic Rhinosinusitis
131
Q

Treatment of Chronic Rhinosinusitis

A

Inflammation: corticosteroids, antifungals, macrolides

Fungus: topical antifungal

Allergy: immunotherapy

Bacterial Biofilm: topical antibiotics, surfactants, mechanical debridement, probiotics

Bacterial Superantigen: antibiotics

Other: saline, irrigation

132
Q

Identify this condition and describe the management:

pt complains of increasing nasal obstruction, inability to smell and a feeling of head fullness

pt is taking aspirin to prevent MI, and has hx of seasonal allergies

exam shows a sessile mass, it is soft and mobile on probing

A

Nasal Polyposis

Sampter’s Triad: polyps, asthma, aspirin sensitivity

TX:

  • diet if allergy due to specific foods
  • immunotherapy
  • decongestants
  • antihistamines
  • steroids
  • avoiding NSAIDS if a trigger
  • leukotriene-receptor antagonists
  • SURGICAL: endoscopic polypectamy and FESS
133
Q

Conductive Hearing Loss

A

Sound conduction is impeded through the external ear, middle ear, or both

134
Q

Identify the condition and describe the management:

pt complains of ringing in his ears, full feeling ears and occasionally has some hearing loss in just the left ear. the pt also complains of periods of vertigo with nausea that lasts a couple of hours.

A

Meniere’s Disease

labrynthine disorder, uncertain etiology, thought to be caused by increased fluid pressure within the ear

usually self limited

**diagnostic work-up: **audiometry, vestibular testing, MRI to rule out acoustic neuroma

**tx: symptomatic treatment - **antiemetic (compazine, tigan), vestibular suppressant (meclizine), diuretics, decrease sodium intake

135
Q

Identify the condition and describe the management:

pt complains of vertigo that lasts for a few seconds after he rolls over in bed or gets up quickly from a chair

A

Benign Paroxysmal Positional Vertigo (BPPV)

caused by otoconia particles from the utricle or sacccule lodging in the posterior semicircular canal

exam: ENT, orthostatic hypotension, ocular exam, balance tests, assess gait, CN assessment

Dix-Hallpike Manuever

symptomatic tx: meclizine

136
Q

Common Ototoxins

A

salicylates

aminoglycosides

chemotherapeutics

137
Q

Identify the condition and describe the management:

pt presents with white patches on the TM (see below) and has reduced movement on pneumatic otoscopy

pt has a prior hx of recurrent otitis media and tympanostomy tube

A

Tympanosclerosis

clacium patches on the TM in response to infection

involves the TM, ossicles, middle ear mucosa - stiffens system

tx: ENT referral

138
Q

Rinne Test

A

Tuning Fork (512) at mastoid, when pt no longers hears sound, place tuning fork adjacent to ear canal to check air conduction

Air conduction better than bone conduction (AC > BC)

Abnormal in Conductive Hearing Loss

139
Q

Whisper Test

A

Patient occludes opposite ear
Examiner whispers questions or commands
Patient answers or follows commands
Avoid testing with finger snapping or ticking watch
Not accurate for Hearing Testing

140
Q

Identify the condition and describe the management:

pt is a 45 yo female

she complains of ringing in her ears, and that she has slowly lost hearing in her right ear

Weber: + Left ear

Rinne: negative

A

Accoustic Neuroma

  • benign tumor that arises from the Schwann cells of CN 8
  • most common in middle age
  • symptoms: tinnitus and hearing loss
  • hearing loss is usually gradual, progressive, unilateral

diagnostics: MRI
tx: srugery or radiothrapy

141
Q

Identify the condition and describe the management:

pt reports reduced ability to hear in his R ear

Weber: lateralizes to R side RInne: R BC>AC

exam shows: pt has a bony overgrowth in the EAC

A

Exostoses / Osteoma

tx: surgery, rarely necessary

can cause impared cerumen migration

142
Q

Tinnitis

A

“ringing” in the ears, preceived internal noise heard by patient with associated hearing loss

can be secondary to vascular problem, intracranial mass, metabolic disorders, medications

if “blood rushing” or “heartbeat” - vascular problem

if bilateral, NOT pulsatile, not instrusive and mild hearing loss - secondary to hearing loss

tx: find the underlying cause and manage that

143
Q

What is the most common PREVENTABLE cause of sensorineural hearing loss?

A

Noise Trauma

high-frequency affected first

tx: aggressive use of noise protection

144
Q

Identify the condition and describe the management:

pt presents with otorrhea from the right ear and complains of hearing loss in the right ear

Weber lateralizes to the right, Rinne: BC>AC

otoscopic exam:

A

TM Perforation

reduces surface area available for sound transmission

usually secondary to chronic OM or trauma

tx: surgery for large perforations

keep ear dry

145
Q

Meniere’s Disease Triad of Symptoms

A

episodic vertigo (Hours)

tinnitis

fluctuating hearing loss - LOW frequency, unilateral

146
Q

Identify the condition and describe the management:

pt complains of unilateral hearing loss

otoscopic exam shows effusion in the middle ear and decreased TM mobility

A

Otitis Media

most common cause of conductive hearing loss in children

TX: treat the OM, possible myringotomy tubes

147
Q

Common Causes of Conductive Hearing Loss

A
  • Cerumen Impaction
  • Foreign Body
  • Otitis Externa
  • Exostoses and Osteomas
  • Otosclerosis
  • Tympanic Membrane Perforation
  • Otitis Media
  • Tympanosclerosis
  • Tumors/cysts of the auditory canal
148
Q

What type of hearing loss is this, and which ear is affected?

weber: lateralizes to the right ear
rinne: R: BC>AC; L: AC>BC

A

conductive hearing loss of the right ear

Weber: lateralizes to the ipsilateral ear in conductive loss

Rinne: bone conduction is greater than air conduction

149
Q

Weber Test

A

Tuning Fork (256) at midline forehead

Sound radiates TO Conductive Hearing Loss ear

Sound radiates AWAY from Sensorineural Hearing Loss ear

150
Q

Identify the condition and describe the management:

pt had a cold last week and now complains of sudden vertigo that lasts for days, she also notes some hearing loss

A

Acute Labrynthitis

inflammation of the inner ear - often after viral URI

tx: symptomatic tx: antiemetic (compazine) and vestibular suppresent (meclizine)

151
Q

Common Causes of Senorineural Hearing Loss

A
  • Presbycusis
  • Noise Trauma
  • Ototoxin Exposure
  • Meniere’s Disease
  • Acoustic Neuroma
  • Acute Labrynthitis
  • Tinnitis
152
Q

Sensorineural Hearing Loss

A

Occurs with dysfunction of the inner ear

problem with cochlea or neural pathway to auditory cortex

mainly affects adults; children can be affected usually secondary to congenital hearing loss

sudden sensorineural hearing loss requires urgent ENT referral if cause cannot be found on exam

153
Q

Identify the condition and describe the management:

pt is a 49 year old female

presents with bilateral hearing loss (less than 50 DB) that has gotten worse

family hx: father had something similar

A

Otosclerosis

abnormal bone deposition at the base of the stapes

leads to fixation of the stapes, preventing vibration

tx: hearing aids or surgery (stapedectomy)

154
Q

Tumors/Cysts of the Auditory Canal

A

Uncommon

refer to ENT or surgical removal

155
Q

What type of hearing loss is this and which ear is affected?

Weber: sound lateralizes to the right ear

Rinne: R: AC>BC; L: AC>BC

A

left ear sensorinueral hearing loss

Weber: sound will latealize the the contralateral ear in sensironeural hearing loss

Rinne: normal hearing or sensorineural loss result in AC>BC (2:1)

156
Q

Identify the condition and describe the management:

pt complains of vertigo that lasts for 3-4 days, but has no hearing loss

A

Vestibular Neuritis:

occurs spontaneously or after a URI

symptomatic tx: antiemetic, vestibular suppressant, antihistamines, benzodiazepines, anticholinergics

157
Q

Identify the condition and describe the management:

pt is a 75 yo male brought in by his wife, he reports increased difficulty hearing the tv and difficulty understanding speech with both ears

audiometry testing shows high pitched hearing loss

A

Presbycusis

  • symmetric, progressive deterioration of hearing - usually in adults and elderly
  • loss of cochlear hair cell function
    • combination of genetic disposition and envrionmental factors
    • secondary to neurovascular injury: HTN, DM
  • high frequency hearing and speech discrimination are affected

TX: audiology consult, hearing aids

158
Q

Identify this condition:

pt presents with a collar of edema and infection of the submandibular, sublingual and submental compartments bilaterally, tongue is pushed superiorly and posteriorly

A

Ludwig’s Angina

tx: manage airway, I&D may be required

159
Q

Identify and describe the management:

pt is a 22 yo acapella singer

Larygnoscope shows: bilateral distinct masses on the anterior vocal cords involving the mucosa and submucosa

A

Nodules

  • bilateral can occur in children and young adults
  • no sex predilection
  • biphasic, early and mature
  • occur at the “striking zone”

TX: voice therapy

160
Q

Identify and describe the management:

Larygnoscope shows: a sessile mass on the mid anterior cord

A

Unilateral Polyp

can be pendunculated or sessile

tx: voice therapy or surgery

161
Q

Grade these tonsils:

A

Grade 4

162
Q

Identify this condition:

pt reports recurrent oral apthous ulcers, gential ulcers, and uveitis

A

Bechet’s

rare immune-mediated small vessel systemic vasculitis

163
Q

Grade these tonsils:

A

Grade 2

164
Q

Identify this condition:

20 yo pt presents with small, round circumscribed ulcers that has a gray floor with an erythmatous halo in her mouth

pt reports prior history and that these typically occur 3-6 times a year and only last a week or so

pt says her brother has something similar

A

Aphthous Stomatitis

  • restricted to the mouth
  • typically resolves in the third decade of life
  • affects 20% of population
  • ulcers last 7-10 days
  • 3-6 episodes a year
  • result of T cell mediated immune response
165
Q

associated conditions with: Aphthous-Like Stomatitis

A
  • Behcet’s Disease
  • Celiac Disease
  • Cyclic Neutropenia (every 21 days)
  • Nutritional Deficiencies (B12, folic acid, & iron)
  • IgA deficiency
  • Immunocompromised States
  • IBD - Chron’s
  • MAGIC Syndrome (Mouth & Genital Ulcers with inflammed cartilage)
  • PFAPA Syndrome (Periodic Fever, Aphthas, Pharyngitis, Adenopathy)
  • Reiter’s Disease
  • Erythema Multiforme
  • Toothpastes - Sodium Lauryl Sulfate
166
Q

Recurrent Respiratory Papillomatosis

A
  • affects mucous membrane of the respiratory tract
    • infection only in keratinocytes of the skin or mucous membrane
  • viral etiology: HPV 6, 11
  • vertical transmission
  • juvenile and adult onset
167
Q

Identify this condition and describe the management:

pt presents with an occluded salivary gland on the mucosa

A

Mucocele

tx: drainage and excision

168
Q

Identify this condition and describe the management:

pt presents with a midline anterior neck mass

examination reveals the mass elevates when the patient swallows and sticks out her tongue

A

Thyroglossal Duct Cyst

remnant of connection between foramen cecum and thyroid

tx: surgical excision

169
Q

Identify this condition:

pt presents with a lace like pattern in her oral cavity

A

Lichen planus

  • not contagious
  • unknown triggers
  • maybe autoimmune

TX: steroids helpful, no known cure

170
Q

Identify this condition:

lateral neck mass, anterior to the SCM

exam reveals the mass opens into the tonsillar fossa

A

Branchiogenic Cyst - second arch

Superficial to CN IX and XII

Superficial to Cartoid Sheath

171
Q

Granulomas

A

Contact - posterior glottis

  • auctioneers, bass singers, throat clearing/coughing
  • GERD

TX:

  • steroids, proton pump inhibitors
  • surgical management
172
Q

Identify this condition:

pt is an adolescent with a sore throat, fever, malasie,

exam: lymphadenopathy over the posterior cervical and occipital nodes, elevated AST/ALT (liver tests)

A

Infectious Mononucleosis

Primary cause: Epstein Barr Virus

Can be detected with the monospot test

173
Q

Identify this condition and describe the management:

pt presents with a mass in the floor of his mouth, it extends inferiorly into the neck

A

Ranula

occlusion of sublingual gland

simple type: lies in the mouth floor

plunging or diving type: pierces mylohyoid muscle and presents as a neck mass

174
Q

Identify this condition:

neck mass, anterior to the SCM

A

Branchiogenic Cyst - first arch

Type 1 - duplication of EAC

Type 2 - intimate association with facial nerve

175
Q

Identify and describe the management:

pt is a female smoker with a very raspy voice

Larygnoscope shows: bilateral masses spread across the cord

A

Bilateral Diffuse Polyposis

common with vocal abuse - leads to edema, vascular congestion and stasis

176
Q

Grade these tonsils:

A

Grade 1

177
Q

Identify this condition:

pt complains of trismus, dysphagia, odynophagia

exam: see below, temp: 100 F

CBC: increased WBC

A

Peritonsillar Abscess

178
Q

Identify this condition:

pt presents with painful, ulcerated, bleeding gums

culture shows polymicrobial anaerobic infection (Borrelia vinventii)

A

Acute Necrotizing Ulcerative Gingivitis (aka Trench Mouth, Vincen’ts Angina)

more common in young adults

predisposing factors: poor nutrition, debilitating disease

tx: antibiotics, surgical debridement

179
Q

Identify this condition:

pt complains of mouth pain, exam shows a cheesy appearance with an ulcerative base

A

Fungal Infection

Candida most common

180
Q

Identify this condition:

pt presents with vesicles in her mouth

exam findings: ulcerated lesions on a hyperemic rim (see below)

A

Herpes Virus

type 1 primarily oral

tx: antivirals

other presentations see below:

181
Q

Leukoplakia

A
  • white patch
  • pre-cancerous lesion
  • need biopsy to rule out carcinoma
  • 0-20% turn into cancer (see image of vocal cord carcinoma below)
182
Q

Grade these tonsils:

A

Grade 3

183
Q

Identify this condition:

5 yo pt presents in the ER, he is bent forward and drooling with stridor

A

Acute Epiglottitis/Supraglottitis

often pediatric presentation

H. flu

examine in O.R. with intubation equipment readily available

184
Q

Identify this condition:

pt presents with a candidal infection at the corner of her mouth

A

Angular Chelitis

associated with decreased vertical height between the mandible and maxilla

tx: restore height, use antifungals

185
Q

describe Otitis Media with Effusion (OME)

A
  • presence of effusion in an asymptomatic patient
  • TM’s appear
    • non-bulging
    • translucent or opaque
    • bubbles or air/fluid levels apparent
  • Tympanoscopy - compliance decrased pressure can be positive or negative
186
Q

describe Bullous Myringitis

A
  • “blisters” on the ear drum
  • caused by: Strep. pneumo or Mycoplasma
    • if pt has chronic nagging cough - more suspicious of mycoplasma
  • antibiotics: Erythromycin or Azithromycin
187
Q

Describe what you see through your otoscope:

A

Retraction

188
Q

Identify this condition and describe the management:

pt presents with severe ear pain that is made worse with chewing and pressure on the tragus

no sxs of fever or URI

otoscopy shows erythematous external auditory canal with moist, white exudate in the canal (see image)

A

Otitis Externa “Swimmer’s Ear”

  • inflammation of th external auditory canal
  • high humidity, frequent or prolonged immersion in water, local trauma can compromise local defenses - leading to inflammation and infection

Causative Organisms:

  • P. aeruginosa
  • children with tympanostomy tubes: S. aureus, S. pneumo, M. cat, Proteus, Klebsiella

TX:

  • Topical Antibiotic Drops
    • Cortisporin otic suspension if TM is intact
  • Acetic Acid Preparations - restore pH
  • Tympanostomy Tube: Quinolone otic drops
189
Q

Identify this condition and describe the management:

pt complains of slight hearing loss, has some itching, denies pain and other symptoms

pt has been utilizing q-tips to clean out her ears

A

Cerumen Impaction

  • usually from mechanical attempts to remove ear wax
  • pt should be educated to leave the ear wax alone

TX:

  • curettage
  • suction (if soft)
  • lavage/irrigation
  • cerumenolytic agents (Debrox, Cerumenex)
190
Q

How do you distinguish Acute Otitis Media (AOM) from Otitis Media with Effusion (OME)?

A

AOM

  • symptoms of acute infection
  • symptoms of TM inflammation

OME

  • no signs of acute infection or TM inflammation
191
Q

Otitis Media has increased frequency in . . .

A
  • Boys
  • Native American/Alaskan Natives
  • HIV
  • Cleft Palate
  • Trisomy 21
  • January/February
192
Q

describe Acute Otitis Media (AOM)

A
  • rapid onset of local and or systemic illness: otalagia, fever, irritability, anorexia or vomiting
  • TM’s are
    • bulging
    • opaque
    • erythematous
  • Tympanometry - compliance decreased, positive pressure
193
Q

Identify this condition and describe the management:

Three days ago you treated a patient for AOM with amoxicillin. Her fever and pain has persisted, and presents swelling and redness behind her ear. Upon examination you notice the ear lobe pushed superiorly and laterally.

A

Mastoiditis

  • rare but serious complication of OM
  • infection of the periosteum of the mastoid bone
  • severe cases: bony destruction and resorption of mastoid air cells

DX: diagnosesd by CT scan

TX:

  • Myringotomy - culture and sensitivity
  • IV abx: Ceftriaxone with nafcillin or clindamycin
  • Surgery for I&D and mastoidectomy if:
    • failure of abx after 24-48 hrs
    • signs of intracranial complications

Complications: meningitis, brain abscess, facial palsy

194
Q

Describe what you see through your otoscope:

A

Scarring on the TM

195
Q

What are the 3 most common infectious organisms that cause Otitis Media?

A
  1. Streptococcus pneumoniae
  2. Haemophilus influenzae
  3. Moraxella catarrhalis
196
Q

Use this card to test your knowledge of surface landmarks on a normal tympanic membrane.

A
197
Q

When is watchful waiting for an otitis media contraindicated?

A
  • children under 2 years old
  • ear symptoms greater than 48 hours
  • fever present
  • severe pain (pain not managed by analgesics)
198
Q

What are the risk factors for Otitis Media in children?

A
  • Bacterial Colonization (S. pneumo, H. flu, M. cat, GAS)
  • Reccurent viral URI’s
    • Eustachian tube dysfunction
  • Smoke Exposure
  • Immunocompromised
  • Bottle Feeding
  • Young Age
  • Genetic Susceptibility/parental history
  • Sibling at home/share room with a sibling
  • Daycare
199
Q

Otoscope Practice

A

An annulus fibrosus
Lpi long process of incus - sometimes visible through a healthy translucent drum
Um umbo - the end of the malleus handle and the center of the drum
Lr light reflex - antero-inferioirly
Lp Lateral process of the malleus
At Attic also known as pars flaccida
Hm handle of the malleus

200
Q

Describe what you see through your otoscope:

A

Chronic Perforation

201
Q

Identify this condition and describe the management:

pt is a 3 year old. hx of a cold last week and now says “my ear hurts.” temp: 99 F

mom reports little Tommy has been irritable lately and is not sleeping well

see otoscope exam photo below & tympanometry results

A

Acute Otitis Media

  • Tympanogram results: positive pressure, decreased compliance

TX:

  • Watchful Waiting
  • Pain Management
  • Antibiotics - Acute course
  • Myringotomy Tubes
202
Q

Identify this condition and describe the management:

A mother brings in her four year old son. Mom has noticed that he is tugging on his ear and itching it a lot. Mom suspects he has decreased hearing on one side. PT does not report pain and does not have any other symptoms.

A

Ear Foregin Body

removal with a bayonette forceps or ear currette under direct visualization

lavage (DON’T lavage vegetable matter)

mineral oil or lidocaine - insect removal

if not easily removed - refer to ENT

complications: laceration, otitis externa, TM perforation

antibiotic drops should be perscribed after removal

**Alkaline batteries can cause liquefying necrosis**

203
Q

Treatment Options for Otitis Media

A

watchful waiting

  • first option
  • educate parents, give the child 48 hours if no improvement or fever develops call back
  • unless
    • child under age 2
    • ear symptoms >48 hours
    • fever present
    • severe pain not managed by analgesics

pain management

  • acetaminophen or ibuprofen
  • topical anesthetic drops (Auralgan/ AB otic)
  • tympanoscentesis

Antibiotics (7-10 days)

  • Amoxicillin (day care, recurrent cases, recent antibiotic useage)
  • Augmentin (amoxicillin/calvulanate)
  • Cephalosporins (cefuroxime, cefpodoxime, cefdinir)
  • Prophylactic antiboitic use in recurrent otitis media is rare!

Myringotomy Tubes

204
Q

What is Recurrent Otitis Media?

A

3 Otitis Media in **6 months **

or

4 Otitis Media in 1 year

205
Q

Identify this condition and describe the management:

cc: some hearing loss
hx: of chronic ear disease and draining that has been unresponsive to treatment

otoscopic examination shows a middle ear cyst with some retraction

A

Cholesteatoma

  • epithelial cyst behind the TM in the middle ear
  • associated with TM retraction or perforation
  • can be destructive and erosive - produces osteolytic enzymes (will errode ossicles, may invade other structures)

DX: CT to make definitive diagnosis

TX: ENT referral

206
Q

A look through the otoscope shows . . . what type of pathology is present?

A

Otits Media

207
Q

A look through the otoscope shows . . . what type of pathology is present?

A

Perforated TM

208
Q

A look through the otoscope shows . . . what type of pathology is present?

A

TM Scarring

209
Q

A look through the otoscope shows . . . what type of pathology is present?

A

Tympanostomy Tube

210
Q

Describe the sinus development of children.

A
  • BORN with ethmoid and maxillary sinuses that continue to develop
  • frontal sinuses APPEAR around age 4
  • not fully developed until adolescence
211
Q

define - referred otalgia

A

otalgia secondary to a problem unrelated to the ear

remember the ear has innervations from: CN V, VII, IX, X and cervical sensory nerves

212
Q

Identify this condition and describe the management:

pt: is a high school wrestler who hates to wear his headgear

A

Auricular Hematoma (Cauliflower Ear)

  • secondary to trauma to the auricle which causes the hematoma
  • can lead to necrosis and resoprtion, possible infection

TX: needle aspiration (high recurrence), definitive treatment: I & D

213
Q

A look through the otoscope shows . . . what type of pathology is present?

A

**Normal **

214
Q

What is this instrument used for?

A

Pneumatic Otoscope

  • utilized to check the movement of the TM
  • TM should move equally back and forth if normal pressure is present
215
Q

A look through the otoscope shows . . . what type of pathology is present?

A

Otitis Media

*note from Erin in lecture - this could also be from a child crying

216
Q

Identify this condition:

pt has a midline mass just below her chin

exam: mass does not move when pt swallows or sticks out her tongue

A

Dermoid Cyst

located in the submental area

endoderm and mesoderm remnants

does NOT move with swallowing or tongue protrusion

217
Q

Identify and describe the management of this condition:

pt: has enlarged parotid and submandibular glands that are tender to palpation, ducts have a purulent discharge

A

Sialoadenitis

tx: antibiotics, hydration, massage of gland, warm compress

218
Q

Benign Neoplastic Salivary Gland Enlargement - Differential Diagnosis

A
  • Pleomorphic adenoma
  • Warthin’s tumor
  • Oncocytoma
  • Hemangioma
219
Q

Benign Neck Masses: Schwannoma

A

solid, slow growing, neurogenic tumor, painless

most common in 25-50 year olds

220
Q

Identify this condition and describe the managment:

pt: reports pain on the left side of her mouth/cheek right before sitting down to eat dinner
exam: observed swelling of salivary gland, palpation of a stone in Wharton’s duct

A

Sialolithiasis

tx: removal of stone by massage or milking the gland
refer: ENT if stone does not pass within 5-7 days

221
Q

Benign Neck Masses: Sebacous Cyst

A

cyst sac, slow growing, painless, moveable

possibly infammed and tender

tx: incision and drainage, excision

222
Q

Benign Neoplasia Neck Mass Differential Diagnosis

A
  • Lipomas
  • Fibromas
  • Sebaceous Cyst
  • Epidermoid Inclusion Cysts
  • Paragangliomas
  • Schwannomas
  • Neurofibromas
223
Q

Identify this condition and describe the management:

pt has a 3 cm (midline) mass on his anterior neck, the mass moves when the patient swallows or sticks out his tongue

A

Thyroglossal Duct Cyst

remnant of descending tract of thyroid

may intermittenly become infected

Management: surgical excision of cyst, tract

224
Q

Malignant Neoplasia Differential Diagnosis

A
  • Metastatic squamous cell carcinoma
  • Lymphoma
  • Rhabdmyosarcoma
  • Neurofibrosarcomas
  • Thyroid Carcinoma
  • Salivary Carcinoma
225
Q

Malignant Neck Masses - Lymphoma

A

occurs in pediatrics and adults

enlarged lymph nodes, non-tender

addtional sxs: weight loss, night sweats

226
Q

Identify this condition and describe the management:

pt complains of mass on her neck

reports s/s of cough, fever, nasal drainage, tonsillar enlargment with exudates

exam shows: enlarged, tender/painful submandibular and anterior cervical lymph nodes

A

Inflammatory Neck Mass: **Reactive lymphadenitis **

secondary to viral or bacterial illness

  • most common bacterial casue: strep and staph infection
  • most common viral: Mononucleosis (EBV)
  • less common causes: Mycobacterium, Tuberculosis, Cat Scratch Disease, Toxoplasmosis, HIV

diagnosis can utilize labs - rapid strep test, CBC, PPD, HIV test, Bartonella, EBV titer, etc.

tx: 10-14 days of antibiotic unless viral (self-limited) - follow up in 2-3 weeks
managment: further work-up if doesn’t resolve in 2-3 weeks

227
Q

Benign Neck Masses: Lipoma

A

soft mass, ill-defined borders, painless

tx: excision if needed

228
Q

Malignant Neck Mass: Rhabdomyosarcoma

A

pediatrics - peak incidence age 5

painless, enlarging mass

229
Q

Congenital Lateral Neck Masses - Differential Diagnosis

A
  • Branchial cleft cysts
  • Lymphangiomas (cystic hygromas)
  • Hemangiomas
230
Q

Identify this condition and describe the management:

pt has a cyst on the anterior border of the his left SCM, it has increased in size over the past year

pt had a cold last week and now the mass is infected

exam: palpation reveals the mass is soft, and does not elicit pain

A

Branchial Cleft Cyst

can be a cyst, sinus or fistula anywhere on the SCM

2nd cleft most common, 1st cleft less common

  • First Branchial Cleft - associated with EAC, Parotid Gland
  • Second Branchial Cleft - associated with Superior pole of tonsil, located on the anterior border of the SCM, between the internal and external carotid arteries, opens into tonsilar fossa
  • Third Branchial Cleft - associated with Pyriform Sinus, located on the anterior border of the SCM, posterior to common carotic, opens into Pyiriform sinus

management: surgical excision of cyst and sinus tract

231
Q

Malignant Neoplastic Salivary Gland Enlargment

A
  • Muccoepidermoid carcinoma
  • Adenoid cystic carcinoma
  • Adenocarcinoma
  • Squamous cell carcinoma
  • Lymphoma
  • Metastasis
232
Q

Inflammatory Salivary Gland Differential Diagnosis

A
  • Acute or chronic sialoadenitis
  • Mumps
  • Sialolithiasis
  • HIV
  • Tuberculosis
  • Cat Scratch Disease
  • Cytomegalovirus
  • First branchial arch cysts/sinus
233
Q

Benign Thyroid Neoplasm Differential Diagnosis

A

Follicular Adenoma

234
Q

Malignant Neck Masses: Metastatic Squamous Cell Carcinoma

A

most common cause of malignant neck mass in adults

primary tumor most likely in aerodigestive tract

235
Q

Benign Neck Masses: Fibroma

A

fibrous or connective tissue, painless

tx: excision if needed

236
Q

Thyroiditis - Thyroid Masses Differential Diagnosis

A
  • Acute thyoiditis
  • Subacute thyroiditis (granulomatous, lymphocytic)
  • Chronic lymphocyte thyroitis (Hashimoto’s)
  • Fibrous thyroiditis (Riedel’s)
237
Q

Metabolic Salivary Gland Enlargment Differential Diagnosis

A
  • Sjogren’s Syndrome
  • Medications
  • Sarcoidosis
238
Q

Identify this condition:

pt presents with a cystic lesion on the floor of his mouth, it plunges through muscle planes into the upper neck

A

Ranula

occurs from mucus extravasation from blocked salivary duct

239
Q

Degenerative Thyroid Masses - Differential Diagnosis

A
  • nontoxic multinodular goiter
  • Graves’ disease
240
Q

Congenital Midline Neck Masses - Differential Diagnosis

A
  • thyroglossal duct cyst
  • dermoid cysts
  • Ranulas (plunging)
241
Q

Inflammatory Neck Mass - Differential Diagnosis

A
  • Cervical adenitis (viral or bacterial)
  • Infectious mononucleosis
  • Atypical mycobacteria
  • Cat scratch disease
  • Tuberculosis
  • Histoplasmosis
  • Toxoplasmosis
  • Accquired immunodeficiency syndrome
  • Granulomatous (sarcoidosis)
242
Q

Malignant Thyroid Neoplasms

A
  • Papillary Carcinoma
  • Follicular Carcinoma
  • Medullary Carcinoma
  • Anaplastic Carcinoma
  • Lymphoma

Adult/Ped Medicine Cumulative Final (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions