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(PA school) CAM I > Highlights ENT I + II > Flashcards

Highlights ENT I + II Flashcards

1
Q

What is the most common cause of otitis externa? Give 3 examples

A

Acute bacterial infection: Pseudomonas aeruginosa, S. epidermidis, & S. aureus

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2
Q

Malignant external otitis is a potential complication of what?

A

Otitis externa

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3
Q

What is a mainstay of otitis externa treatment? Describe how it’s used in mild and moderate cases

A

Topical therapy:
1) Mild: Topical acidifying agent + glucocorticoid (i.e., acetic acid + hydrocortisone TID-QID) x 7 days
2) Moderate: Topical antibiotic + glucocorticoid (i.e., Cipro HC BID, Cortisporin TID-QID) x 7 days

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4
Q

What usually is the cause of obstruction of Eustachian tube, causing AOM?

A

Viral URI or seasonal allergic rhinits (adults)

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5
Q

Otalgia is a common symptom of what in children?

A

AOM

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6
Q

A bulging TM is a classic exam finding of what condition?

A

AOM

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7
Q

1) How should you treat AOM with antibiotics in children if they haven’t had antibiotics in the past month?
2) What about if they have?
3) How long should it last?

A

1) Amoxicillin 80-90 mg/kg/day divided q8h or q12h
2) Amoxicillin-clavulanate (Augmentin) 90/6.4 mg/kg/day PO divided BID
3) Duration of therapy: 10 days for < 2 y/o & 5-7 days for > 2 y/o

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8
Q

What often precedes AOM?

A

Middle ear effusion

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9
Q

What are the 3 referral criteria for AOM?

A

1) Recurrent otitis media (> 2 episodes in 6-month period)
2) Persistent hearing loss following AOM (> 1-2 weeks)
3) Chronic TM perforation (> 6 weeks)

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10
Q

1) Define chronic otitis media.
2) What’s its hallmark?

A

1) Recurrent infection of middle ear and/or mastoid in presence of TM perforation
2) Purulent aural discharge

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11
Q

Define Otitis Media with Effusion (OME) (aka Serous Otitis Media)

A

Presence of middle ear effusion without signs of acute infection

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12
Q

Retraction of the TM is possible with what middle ear condition?

A

Eustachian tube dysfunction

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13
Q

Unilateral SNHL and continuous disequilibrium are symptoms of what?

A

Acoustic neuroma

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14
Q

A sensation of motion without actual motion is what?

A

Vertigo

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15
Q

What must be distinguished from imbalance?

A

Vertigo

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16
Q

What two etiologies of vertigo do you need to differentiate between?

A

Peripheral and central

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17
Q

The Epley maneuver is used to treat what condition?

A

BPPV

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18
Q

underlined slide 97

A
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19
Q

Define otalgia

A

[Ear] pain out of proportion to PE findings

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20
Q

What is an absolute contraindication to diving?

A

TM perforation

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21
Q

You must differentiate between 2 etiologies of vertigo; describe the general symptoms of each

A

1) Peripheral: onset is sudden, often with tinnitus & hearing loss, usually horizontal nystagmus
2) Central: onset is gradual, not associated with auditory symptoms

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22
Q

What is the typical triad of Ramsay Hunt Syndrome?

A

1) Ipsilateral facial paralysis
2) Otalgia
-(pain out of proportion to PE findings)
3) Vesicles in EAC or on auricle

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23
Q

Name a peripheral cause of vertigo that has NO hearing loss or tinnitus

A

Migrainous vertigo

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24
Q

1) Most common suppurative complication of AOM is what?
2) What is the hallmark symptom of this complication?

A

1) Mastoiditis
2) Tenderness over the mastoid process

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25
Q

True or false: With mastoiditis, refer to an otolaryngologist early

A

True

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26
Q

What is a condition characterized by episodic vertigo, tinnitus, & sensorineural hearing loss?

A

Meniere’s disease

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27
Q

What is characterized by episodes (plural) of vertigo?

A

Meniere’s disease

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28
Q

How is mastoiditis diagnosed?

A

Clinically

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29
Q

How should you first try to treat Meniere’s?

A

Diet & lifestyle adjustment: Low-salt diet

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30
Q

True or false: tinnitus is a symptom, not a disease

A

True

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31
Q

Name a condition that you should think of when a pt complains of ear fullness

A

Meniere’s Disease

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32
Q

What is the most common cause of tinnitus?

A

Sensorineural HL

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33
Q

Fluctuating aural symptoms (reduced or distorted hearing, tinnitus, or fullness) in affected ear is typical of what condition?

A

Meniere’s disease

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34
Q

The most common risk factor for tinnitus is what?

A

Sensorineural HL

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35
Q

What two things should you examine the ear for when a pt complains of tinnitus?

A

Cerumen impaction & effusion

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36
Q

1) Audiometry is necessary to Dx what type of tinnitus?
2) When is MRI indicated to Dx tinnitus?

A

1) Non-pulsatile cases
2) Unilateral cases

37
Q

MRA/MRV & temporal bone CT are necessary to Dx what type of tinnitus?

A

Pulsatile

38
Q

List 2 important ways to treat tinnitus

A

1) Avoidance of exposure
2) Masking [with music, etc]

39
Q

What is the goal of tinnitus treatment?

A

Decrease awareness & impact on quality of life

40
Q

Obstruction is a mechanism of what type of HL?

A

Conductive (CHL)

41
Q

CHL (conductive HL) is most commonly due to what two things?

A

1) Cerumen impaction
2) Transient ETD

42
Q

What type of HL is usually correctable?

A

CHL

43
Q

1) What is the most common form of SHL (sensory HL)?
2) Is it correctable/ reversible?

A

1) Presbycusis
2) Usually not

44
Q

MRI or CT is indicated for what two types of HL patients?

A

Progressive or sudden asymmetric SNHL

45
Q

What type of HL is also known as age related HL (ARHL)?

A

Sensorineural

46
Q

List 3 characteristics of sensorineural HL

A

Gradually progressive, predominately high-frequency, & symmetrical

47
Q

How is ARHL traditionally managed?

A

Hearing aids

48
Q

What is the most common neoplasm of EAC?

A

Squamous cell carcinoma (SCC)

49
Q

When should you suspect SCC of the EAC?

A

If otitis externa fails medical therapy

50
Q

Are primary middle ear tumors common?

A

No, they’re rare

51
Q

Acoustic neuroma (Vestibular Schwannoma) is also called what?

A

Inner ear neoplasm

52
Q

Mucosal trauma or irritation, like nose picking, can cause what kind of epistaxis?

A

Anterior

53
Q

True or false: Anticoagulation or antiplatelet medication can cause epistaxis

A

False; NOT a cause, just associated with

54
Q

What is the most common form of epistaxis?

A

Anterior septum (Kiesselbach’s plexus) epistaxis

55
Q

List 2 important aspects of medical history should you get for epistaxis

A

1) Predisposing conditions [to bleeding]
2) Comorbidities potentially exacerbated by blood loss

56
Q

What type of pt should you perform a typical PE for epistaxis on?

A

Stable pts

57
Q

1) What is the first thing to do when it comes to managing epistaxis?
2) When should you refer to the local ED?

A

1) Severe active bleeding & hemodynamic instability correction
2) Ongoing bleeding > 15 min

58
Q

Initial tamponade is a treatment for what?

A

Anterior epistaxis

59
Q

True or false: Cauterization and packing are two, but not all, of the appropriate treatment measures for anterior epistaxis

A

True
(initial tamponade is the third one)

60
Q

Urgent ENT consultation is necessary for what kind of epistaxis?

A

Posterior

61
Q

What is the 5th most common chronic disease in US?

A

Allergic rhinitis

62
Q

Pollens & spores are the most common cause of what?

A

Seasonal AR (allergic rhinitis)

63
Q

What is the allergic triad?

A

1) Allergic rhinitis
2) Asthma
3) Atopic dermatitis

64
Q

Pale or violaceous/bluish turbinate mucosa with clear rhinorrhea is a symptom of what?

A

Allergic rhinitis

65
Q

“Cobblestoning” of posterior pharynx can be associated with what common condition?

A

Allergic rhinitis

66
Q

Infraorbital edema or darkening associated with allergic rhinitis is also called what?

A

“Allergic shiners”

67
Q

True or false: Allergies can be diagnosed clinically based on H&P

A

True

68
Q

What is the most important thing to treat allergic rhinitis (besides pharmacotherapy)?

A

Environmental control measures & allergen avoidance

69
Q

Intranasal corticosteroids (i.e., fluticasone) may be appropriate for what?

A

Allergic rhinitis

70
Q

1) The 1st line for mild allergic rhinitis in pregnancy is what?
2) What about for moderate-to-severe cases in pregnancy?

A

1) Intranasal cromolyn sodium
2) Intranasal corticosteroids

71
Q

What should you avoid regarding allergic rhinitis during pregnancy?

A

1) Antihistamine nasal sprays
2) Oral and nasal decongestants
3) Initiating immunotherapy

72
Q

True or false: non-allergic rhinitis can be diagnosed even if only one of the four cardinal symptoms is present

A

True

73
Q

4 cardinal symptoms of non-allergic rhinitis

A

1) Nasal congestion
2) Post-nasal drainage
3) Sneezing
4) Rhinorrhea

74
Q

What is the easiest way to differentiate allergic and non-allergic causes of rhinitis?

A

Non-allergic = later age of onset (usually > 20 y/o)

75
Q

“Rebound nasal congestion” is also called what?

A

Rhinitis medicamentosa

76
Q

What is the most important tool in treating rhinitis medicamentosa?

A

Pt counseling

77
Q

Differentiate between acute and chronic rhinosinusitis

A

1) Acute rhinosinusitis: symptoms < 4 weeks
2) Chronic rhinosinusitis: symptoms persist > 12 weeks

78
Q

What makes up most cases of acute rhinosinusitis?

A

ARS with viral etiology (common cold)

79
Q

The 3 most common bacteria associated with ABRS are:

A

SP, HI, MC
Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis

80
Q

Purulent nasal discharge and facial pain or pressure are typical symptoms of what?

A

Acute rhinosinusitis

81
Q

List the 5 more common features of a true bacterial sinusitis (ABRS):

A

1) Fever &symptom duration > 10 days
2) Maxillary toothache
3) Initial symptom improvement, then worsening of symptoms (“double worsening”)
4) Cacosmia (sense of bad odor in the nose)
5) Unilateral facial pain

82
Q

True or false: CT imaging is NOT helpful in differentiating viral & bacterial etiology of acute rhinosinusitis

A

True

83
Q

1) What pain would a pt experience when bending forward with acute rhinosinusitis?
2) Direct palpation of sinuses may provoke what in acute rhinosinusitis?

A

1) Pain localized to sinuses.
2) Pain

84
Q

True or false: Imaging is not indicated in patients with uncomplicated ARS

A

True

85
Q

True or false: any ARS findings on imaging are going to be nonspecific for ARS

A

True

86
Q

True or false: antibiotics are NOT indicated for acute viral rhinosinusitis, just supportive care

A

True

87
Q

ABRS can be treated with what 2 antibiotics?

A

1) If no penicillin allergy: Amoxicillin-clavulanate
2) If allergy: Doxycycline

88
Q

List some signs of complicated ARBS

A

1) Papilledema (or basically any other eye changes)
2) Neck stiffness or other meningeal signs
3) Proptosis

89
Q
A

(PA school) CAM I (29 decks)

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