HEENT 2 Flashcards
tonsil sinus lymphatic drainage? 4 cmpts? membrane cells/APC?
deep cervical lvl2/jugular digastric. reticular crypt epithelium, extrafollicular area, mantle zone, germinal center. transport ag to epith layer to T cells -> B cells in germinal zone make ab
B lactamase against?
s pneu, H flu, Morax; provides PCN resistance to group A strep
types of tonsillar dz (5). know sxs, dx, tx of ea
tonisillitis, obstructive tonsillar hypertophy, peritonsillar abscess, congen teratoma/hemangioma/lymphangioma/cystic hygroma; neoplasm (nonhodgkins, sCC)
indic vs modern techniques vs complications of tonsillectomy
3+ infxns/yr, halitosis vs bipolar scissor, thermal weld, coblation, monopolar cautery, harmonic scalpel, laser vs 1/2ndary hem 5-8d postop; AA sublux (Down’s = AA lax; Grisel’s = ant long lig lax, vert body decalcified)
what are the 5 spaces spanning the neck? know details of ea
superficial, true retropharyngeal, danger, prevertebral, visceral vascular
superficial vs deep cervical fascia. know details of ea layer in deep cervical
divided by platysma; from zygoma & facial express muscles to chest/shoulders vs superficial/investing layer -> surround neck, parotid, submandib gland, scm/trap, masseter; middle/visceral layer -> surround aerodigestive tract & thyroid, 2 divisions (muscular around infrahyoid strap & visceral); deep/prevertebral layer -> true retropharyngeal space
retropharyngeal abscess etio/bacteria vs sx vs dx vs tx
from URTI/oral infxn to node of Henle; B hemolytic strep, staph vs <6yo, sore throat, dysphagia, fever vs uni retropharyngeal bulge (DON’T palpate), XR for size, CT for carotid/abcsess, MRI, Us; inc WBC, blood cx vs monitor airway, avoid trauma, intub, trach/cricothyrotomy, I&D if you know carotid location
danger space infxn etio vs dx vs tx
infxn from deep neck space -> descending necrotizing mediastinitis vs img: midline lesion T1/T2 vs CT surg or similar to retropharyngeal tx
prevertebral space infxn etio vs sx vs dx vs tx
vertebral osteomyelitis by staph, TB via hematogenous spread (IVDU) -> neck/back pain, radicular pain vs midline lesion on img vs abx, drain, neurosurg
visceral vascular space infxn etio vs sx vs complications
IVDU vs induration, tender sCM; torticollis opposite side, spike fever vs sepsis mediastinitis, carotid rupture -> sentinel ENT bleed
Lemierre’s syndrome & tx
Fusobacterium necrophorum = embolized into internal jugular vein –> occluded –> septic thrombus; jugular thrombophlebitis assoc w/ posterior pharyngitis. I&D if abscess, 4-6wks abx
Ludwig’s angina & tx
dental -> sublingual space infxn, retro tongue displace -> airway obstruction, submental swell. airway, IV abx, I&D, dental extraction
sx of thyroglossal duct cyst vs branchial cleft/Cervical lymphoepithelial cyst vs dermoid cyst vs cystic hygroma/lymphangioma vs hemangioma vs laryngocele
good vs watery/mucous lat mass on scm d/t incomplete involution of branchial cleft vs midline/orbit cheesy desquam cyst <3yo vs benign uni/multilocular post triangle straw mass -> airway obstruct, assoc w/ Down/XXY/Noonan vs dome lobulated red/blue mass slowly involuting at 18-24mo vs dil/hern laryngeal saccule -> mass in neck/supraglottic region -> hoarse, airway obstruct
lipoma. Dx vs tx
- Most common soft tissue tumor
- rubbery, circumscribed, encapsulated mature adipose. PE; US, CT, MRI to r/o liposarcoma. bx if sx or >3cm, excised if bothersome
reactive viral vs bacterial vs persistent generalized lymphadenopathy
most common cervical lymphadenopathy in children; underlying URI from adeno, rhino, enterovirus; persists or >1cm -> w/u vs s aureus, group A strep; submandib or jugulodigastric tx w/ empiric abx, FNA + I&D vs neck, HIV/low CD4 -> tx underlying HIV
infectious mono vs cat scratch dz sx; dx; tx
EBV, saliva from infected person; spleno/hepatomegaly, Burkitt’s lymphoma, nasopharyngeal ca. incubation 4-6wks. supportive vs Bartonella from kittens infecting immunocompetent/promised; submandib, periauricular papules. clinical, indirect fluorescent ab. resolve on own, azith
non-TB mycobacterium sxs; dx; tx vs cutaneous TB sxs; dx; tx
Mycobacterium intracellulare in soil, water, animals; uni subacute/chronic violaceous in ant triangle or parotid in immunocompetent; weakly pos TsT. isolation of the organism via FNA. Complete surgical excision, abx for children -> clarith or azith + ethambutol and/or rifampin/rifabutin vs scrofuloderma from extrapulm TB in submandib, parotid, supraclavicular. Histopath for AFB by FNA or lymph node biopsy. tx systemic TB
sarcoidosis sxs vs dx vs tx
multisystem noncaseating granulomas, fatigue, fever, cough; hilar LAD in lung; skin w/ erythema nodosum, maculopapular lesions vs clinical vs NSAIDs for arthralgia. Observation. Steroids if involving mult organs
allergen immunotherapy? mechanism? mech of allergies? know advantages
scit -> wkly/monthly injections 3-5y of allergen -> isotype switch from E to G; or slit. ag taken up by dendrites in mouth (fewer mast cells) -> Th2 -> igG; ag reaching si -> Th2 in Peyer’s patch -> igA -> periph tol. allergen -> Tfh -> IgE -> mast cells -> cytok. think pharm
Nasopharyngeal angiofibroma vs Sinonasal papillomas vs Plasmacytoma vs Nasopharyngeal carcinoma
Benign, vascular, male vs Squamous, resp epithelium; HPV 6 or 11; Benign but aggressive vs Malignant plasma cell tumor vs Malignant epith cell tumor
- How children hear influences their?
- Children before 6 m/o have what than children identified after 6 m/o?
- Hearing screening recommended for all?
- In children who have unremediated hearing handicaps, the ability to discriminate what?
language, behavioral, social, and eventually academic development. higher language levels. newborn. background noise from speech = impaired -> severely hinder child’s develop normal speech and language -> Learning disabilities and emotional difficulties
outer vs mid vs inner ear poor hearing causes
congen microtia/atresia, infxn, trauma, tumor vs congen atresia ossicles, Etube dysfxn, Tumors: Langerhans cell histiocytosis, squamous cell carcinoma, cholesteatoma, otosclerosis vs congen, Viral cochleitis – sudden loss, Meniere’s disease – episodic vertigo, noise exposure, inner ear traum/barotrauma, acoustic neuroma, stroke/TIA, thyroid, DM, syphilis, MS, Chiari
nml hearing vs mild vs mod vs severe hearing loss threshold
0-20dB vs 25-39dBHL vs 40-68dBHL vs 70-94dBHL -> can’t hear quieter than 95dB
how to eval hearing loss? unexplained vs sudden SHL cause? how to tx?
whisper test, Weber and Rinne, pneumoscopy, audio assess. blood sugar, CBC, TSH, syphillis vs syndrome not dx rapid loss in morning or <12h -> referral to ENT; infectious cause. high-dose steroid taper or injection, abx if infectious
Presbycusis def vs cause vs sx vs tx
bil hearing loss w/ advancing age, conductive and/or central dysfxn but always affect sensory cells vs loss hair cells, dec fxn of TM or ossicles, vasc dz (HTN, HLD, DM, aterosclerosis) vs sound less clear & low vol, hear men voices better, background noise inc difficulty, tinnitus vs tx vasc dz
socioacusis vs nosoacusis
d/t environ like occupation & recreational noise, nml wear/tear vs intrinisic bio factors like comorb, diet, smoke/alc
Meniere’s/idio endolymphatic hydrops def w/ cause vs sx vs tx
2ndary to interfering nml prod or resorption of endolymph like inc hydraulic pressure in inner ear, endo abnlities, electrolyte imbal, trauma, autoimmune, infxn -> accum in mem labyrinth vs fluctuating hearing loss, occasional vertigo, tinnitus, aural fullness vs IV diazepam/valium, IV fluid for nausea/dehydration, Steroids, Meclizine PRN, avoid triggers, diuretics 3mo trial Rowan tree; surg if diuretics trial fail, endolymph sac decompress/shunt, Transtympanic medication perfusion, Vestibular nerve sectioning, Labyrinthectomy – fully lose hearing
acoustic neuroma def vs cause vs sx vs tx
intracran, extraaxial tumor of schwann on coch or vestib n vs direct injury to coch n -> progressive SHL, or interrupted blood supply -> sudden hearing loss vs unilat hearing loss + tinnitus, disequil from lg tumors, facial numb, hypoesthesia of teeth vs depends on age, size/location tumor but: old pt + sm tumor -> MRI; everything else -> radiosurg
acute otitis media def vs bact & viral cause vs sx vs tx
mid ear purulent perfusion w/ inflam in febrile children vs s pneu/H flu/Morax, group A strep/staph; RSV/flu/corona enhance bact adherence to nasopharynx, para, adeno, entero; allergy, congested Etube vs TM bulging, opac, dec mobility; otalgia, fever, dec hearing; vertigo, tinnitus, chronic allergies, sinusitis vs pain meds, antihist, decongest, abx if recurrent or severe otalgia/fever
Waldeyer’s ring
- Adenoids
- Palatine tonsils
- Lingual tonsils
- Lateral bands
- Extratonsilar lymphatics
o Posterior pharynx
o Laryngeal ventricles
ex of ototoxic drugs (4 types)
o Analgesics: ASA, NSAIDs
o Abx: aminoglycosides, erythromycin, tetracycline
o Chemotherapeutics: bleomycin, cisplatin
o Loop diuretics: ethacrynic acid, furosemide, torsemide
vibratory vs nonvibratory tinnitus. periph vs central causes of tinnitus?
transmission to cochlea of vibrations from adjacent tissues or organs –> assess bp vs biochemical changes in nerve ending. BPV, vestib neuritis, labyrinthitis, HZV, Meniere, otosclerosis, perilymphatic fistula vs cerebellar hem, cerepontine angle tumor, cerebrovasc dz, MS, vert a dissect, migraine
disequil def vs indic for imging
abnlity of brain, spinal cord, cerebellum, periph n from B12 defic or other CNS dz -> at least 2: visual loss, proprioceptive loss, chronic vestibular damage, and orthopedic disorder vs cerebellar sxs/atax, cranial neuropathies, h/o CVD/A
CVD vs vertebrobasilar insufficiency vs lacunar infarct in pons/cerebellum
no blood Supply to CNS from emb, hem, thrombus vs vertigo, visual sxs from emb/thrombus vs rapid hemiparesis, atax, apraxia, aphasia from basal ganglia, thal, internal capsule, pons
how to tx Bell’s palsy?
short term glucocorticoids, artificial tears, PT, surg decompression for hearing loss/facial n dysfxn, brow ptosis correction, long term botox for synkinesis/face spasm, insert wts to upper lid & suspend lower lid for lid closure
allergic vs nonallergic rhinitis
asthma or atopic eczema, <20yo, szn>per; antihist, LT antag, decongest, steroid nasal spray vs chronic, >20yo, per>szn; steroid nasal spray, nasal irrig, ipra
NAREs
perennial sneeze, rhinorrhea, pruritus, anosmia. nasal smear = pos for eos, allergy screen neg. tx w/ steroids +/- antihist
rhinitis medicamentosa. other sxs? tx?
rebound congest from overusing decongestants. punctate bleed, erythematous mucosa, vasoconstrict. stop meds 1 nostril at a time, topical/oral steroids bil and taper off 1 wk
mono = what type of tonsillitis; tx? peritonsillar abscess sx vs tx
exudative; steroids, don’t give amox -> rash. hot potato voice, uvula dev opposite side vs abx, I&D, Quinsy tonsillectomy
airway foreign body def vs sx vs dx vs tx
<3yo, small/food stuck in R bronchus vs cough/choke, wheeze vs inspiratory stridor -> supraglottic, biphasic stridor -> glottic, expiratory stridor -> subglottic; CXR, fluoroscopy, CT, bronchoscopy; coin/disk in esop/hypopharynx -> lat, larynx/airway -> A/P vs Heimlich if can’t speak/cry & TOTAL airway obstruct, brochoscopy
warthin tumor vs pleomorphic adenoma
parotid gland; smoke. Us, MRI, FNA. superficial parotidectomy vs parotid gland; head/neck rad. CT, MRI, FNA, core needle bx. superficial or total parotidectomy
sup vs mid vs inf turbinates do? all contain what?
heat, humidify, filter air; direct airflow vs direct air to max, eth sinus vs condition air; direct airflow. pseudostrat mucociliary escalator, goblet cells, vasc plexus delivering immune cells
acute vs chronic suppurative OM
otalgia, fever in peds; vertigo, tinnitus in adults. dx: immobile TM, bulging TM, yellow, purulent/exudate. tx: abx vs >3mo, TM perforation, purulent, mucous threads, Pseudo/staph/strep. dx: otoscopy, cx. tx: abx, myringotomy, tympanoplasty, mastoidectomy
