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ENT > minimal criteria > Flashcards

minimal criteria Flashcards

1
Q
  1. Symptoms and clinical features of diffuse otitis externa
A

Symptoms
 Earache;
 The external part of the ear canal is painful (especially the tragus);
 Discharge, itching;
 Ear congestion, hearing loss;
 Fever is uncommon.
Clinical findings
 Swelling and hyperemia of the skin of the ear canal;
 Serous or purulent discharge;
 Accumulation of debris in the ear canal;
 Tympanic membrane appears to be normal.

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2
Q
  1. Symptoms and clinical features of acute otitis media (AOM) – suppurative
    form
A 
Symptoms
 Earache;
 Hearing loss;
 Nasal discharge and congestion;
 Fever, malaise;
 If perforation is present: otorrhea
Clinical findings
 Ear canal appears to be normal;
 Hyperemia of tympanic membrane;
 Later in the course of the disease: marked bulging of the tympanic membrane,
subsequently spontaneous perforation can develop.
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3
Q
  1. Causes of acute hearing loss
A

Conductive type:
 wax, foreign body;
 acute tubal occlusion, otitis media (OME/AOM);
 trauma (e.g. perforation of the tympanic membrane).
Sensorineural type:
 Noise (acute) induced hearing loss;
 Viral infection;
 Vascular causes;
 Toxical damage (medication, chemicals);
 Traumas.

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4
Q
  1. What is to be done in case of acute sensorineural hearing loss?
A

In case of acute sensorineural hearing loss, immediate intravenous
nootropic/vasodilatating therapy or steroid bolus treatment is necessary with
hospitalization; meanwhile detailed investigation is required to be carried out to
clarify the etiology. The earlier the treatment is started, the better the outcome is.

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5
Q
  1. Recognition of hearing loss in childhood
A 
Signs of hearing loss in childhood:
 the newborn does not react to sounds;
 tone of crying is unusual;
 babbling period does not appear;
 visual orientation is dominant;
 speech development is delayed;
 tone, pitch, intensity, melody and rhythm of the speech is pathologic;
 articulation disorders;
 worse reading and writing skills
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6
Q
  1. Causes of ear pain
A

 Primary otalgia
 Otitis;
 Tumors of the ear;
 Referred ear pain
 Tumors and inflammations of the larynx, pharynx, tonsils, base of the tongue;
 Dental inflammations, temporomandibular joint syndrome, neuralgic pain.

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7
Q
  1. Complications of acute otitis media (AOM)
A 
Extracranial
 Intratemporal
 Acute mastoiditis;
 Zygomaticitis;
 Petrositis;
 Facial nerve palsy;
 Labyrinthitis;
 Extratemporal
 Abscess: subperiosteal, preauricular, suboccipital, Bezold's abscess;
Intracranial
 Extradural abscess;
 Sinus phlebitis - sinus thrombosis;
 Subdural abscess;
 Meningitis, encephalitis;
 Brain abscess;
 General: sepsis.
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8
Q
  1. Clinical features and symptoms of acute mastoiditis
A

Associated with, or following acute otitis media;
 The pinna is pushed forward;
 Retroauricular pain, erythema;
 The posterior wall of the external ear canal is swollen, seems to be lowered;
 Pulsating, severe pain;
 Pulsating otorrhea.

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9
Q
  1. Causes of unilateral otitis media with effusion (OME) in adults and childhood
A

Chronic dysfunction of the Eustachian tube (adenoid vegetation or nasopharyngeal
tumor)
In adults, the possibility of a nasopharyngeal tumor must not be left out of
consideration!

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10
Q
  1. How to diagnose vertigo caused by vestibular disorders
A

Patient history:
 Type of vertigo (sensation of spinning or falling);
 Vegetative symptoms, nausea, vomiting.
Examination:
 deviation, tilting;
 spontaneous nystagmus and nystagmus provoked by head movements.

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11
Q
  1. Causes of peripherial facial palsy (list)
A

 Bell’s palsy;
 Herpes zoster oticus;
 Other viral or bacterial infections (HSV, EBV, Lyme);
 Acute and chronic middle ear diseases (acute and chronic middle ear infections,
cholesteatoma, rarely tumors);
 Tumors of the pontocerebellar angle, vestibular schwannoma;
 Cranial traumas (pyramid bone fractures), extratemporal traumas;
 Malignant tumors of parotid gland.

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12
Q
  1. Primary management of epistaxis/nosebleeding (at home/ambulance/by GP)
A

 The patient should lean forward with open mouth, firm digital pressure should be
applied to both nasal alae for 10 minutes;
 Ephedrine/nasal drop/vasocontrictor solution-imbibed cotton or spongostan
should be applied in nasal cavity;
 Cold compress should be applied to the nape of the neck and to the nasal dorsum;
 Blood pressure-measurement, antihypertensive treatment if needed.

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13
Q
  1. Management of epistaxis/nosebleeding (anterior, posterior) by ENT
    professionals
A

 Blood pressure-measurement, antihypertensive
treatment - if needed;
 Visible bleeding source: chemical cauterization (trichloroacetate, silver nitrate) or
coagulation (bipolar electrocoagulation);
 Anterior nasal bleeding: anterior nasal packing;
 Posterior nose bleeding: posterior nasal packing (Bellocq tamponade), balloon
catheter.

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14
Q
  1. Management and complications of nasal folliculitis and furuncles
A

 Circumscript folliculitis: local therapy with antibiotic and steroid containing
creams, vapor coverage;
 The patient should be told not to pick or squeeze the lesions;
 For furunculosis and/or phlegmonous reaction, parenteral antibiotics should be
administered, along with vapor coverage;
 The infection is usually caused by Staphylococcus aureus;
 Possible complications: Facial phlegmone, angular vein thrombophlebitis,
cavernous sinus thrombosis.

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15
Q
  1. Types of rhinitis (list)
A

 Common infections: Simple acute rhinitis, purulent rhinitis;
 Specific forms of Rhinitis: TB, syphilis, sarcoidosis;
 Allergic rhinitis
 Atrophic rhinitis (oezena)
 Rhinitis sicca anterior.
 Other causes: idiopathic, vasomotoric, hormonal, drug-induced, rhinitis
medicamentosa, occupational (caused by irritants) foodstuffs. (3 causes are
required from the “other” group)

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16
Q
  1. Clinical features and management of angioedema (Quincke-edema)
A

Symptoms and clinical features:
 urticaria, edema in the head and neck region;
 dysphagia, globus feeling or visible swelling in the throat, choking;
 in a severe form: anaphylaxis;
Treatment: antihistamines, steroids, adrenaline, maintaining free airways:
cricothyrotomy/tracheotomy – if needed.

17
Q
  1. Complications of paranasal sinus infections (list)
A 
Extracranial complications
 Periorbital cellulitis;
 Subperiosteal abscess;
 Orbital phlegmone / abscess;
 Osteomyelitis;
 Sepsis;
 Intracranial complications
 Meningitis;
 Epi/subdural or brain abscess, encephalitis;
 Cavernous sinus thrombosis.
18
Q
  1. Where does the patient localize the pain in cases of frontal, maxillary,
    ethmoidal or sphenoidal sinusitis?
A

 Frontal sinusitis – forehead;
 Maxillary sinusitis – face;
 Ethmoidal sinusitis –periorbitally, between the eyes;
 Sphenoid sinusitis – crown of the head, referring to the occipital area;
 All forms of sinusitis can cause diffuse headache.

19
Q
  1. Causes of unilateral nasal obstruction and discharge in childhood and in
    adulthood
A 
Childhood:
 foreign body;
 sinusitis;
 nasopharyngeal angiofibroma;
 congenital malformation: choanal atresia, meningoencephalocele.
 Adulthood:
 nasopharyngeal tumors;
 deviation of the nasal septum;
 hypertrophy of turbinates;
 trauma and it’s late consequences;
 diseases causing nasal cavity obstruction (polyp, benign and malignant
tumors);
 rhinosinusitis.
20
Q
  1. ENT diseases causing headache
A

 Viral infection of the upper airways;
 Inflammation of nasal sinuses: (acute and chronic);
 Benign and malignant tumors of nasal sinuses;
 Cervical: cervical vertebra disorders, spondylosis, myalgia;
 Complications of otitis and sinusitis: mastoiditis, meningitis, brain abscess,
inflammation of the petrous pyramid;
 Neuralgias;
 Pain of temporomandibular joint.

21
Q
  1. Most frequent causes of dysphagia
A

 GERD;
 Globus feeling, psyhogenic disorders;
 Inflammation in the mesopharyngeal, hypopharyngeal and laryngeal region;
 Tumors in the mesopharyngeal, hypopharyngeal and laryngeal region;
 Neuralgia (n. IX, n. X);
 Sensorial and motor innervation disorders: sensorial disorders in supraglottical
region;
 Foreign bodies in the hypopharynx and oesophagus;
 Esophageal motility disorders, achalasia;
 Diverticulum (e.g. Zenker);
 Esophageal, hypopharyngeal stenoses;

22
Q
  1. Indications of tonsillectomy (absolute and relative)
A

Absolute indications:
 rheumatic fever;
 peritonsillar abscess;
 tonsillogenic sepsis.
Relative indications:
 chronic tonsillitis;
 recurrent tonsillitis;
 tonsillogenic or posttonsillitis focal symptoms;
 marked hypertrophy of the tonsils causing mechanical obstruction;
 if a tonsillar tumor is suspected;
 obstructive sleep-apnea syndrome or other obstructive sleep-related breathing
disorders;
 severe orofacial / dental disorders causing narrow upper airways.

23
Q
  1. Clinical features and symptoms of peritonsillar abscess
A

 Throat pain, referred ear pain;
 Difficulty in swallowing;
 Trismus, the speech is thick and indistinct;
 Oral fetor;
 Fever, insomnia, loss of appetite;
 Swelling, redness and protrusion of the tonsil, faucial arch, palate and uvula; the
uvula is pushed towards the healthy side.

24
Q
  1. Peritonsillar abscess – treatment
A

 Drainage of the abscess - puncture, incision, daily opening of the abscess cavity;
 Tonsillectomy:
 abscess-tonsillectomy;
 tonsillectomy 6 weeks after recovery;
 Antibiotics, decreasing edema, analgesics, administration of fluids.

25
Q
  1. Clinical features, symptoms and complications of para- and retropharyngeal
    abscesses
A

Symptoms:
 throat and neck pain, foreign-body sensation, fever, difficulty in swallowing,
trismus, torticollis, swelling of the lateral or posterior pharyngeal wall, thick
speech, laryngeal/oropharyngeal edema;
Complications:
 oropharyngeal and laryngeal edema, septicemia, mediastinitis, choking.

26
Q
  1. Pathogens of tonsillitis and pharyngitis, indication of antibiotic treatment
A

Pathogens:
 Viral (80-90%);
 adenovirus, rhinovirus;
 (EBV - infectious mononucleosis);
Bacterial:
 Streptococcus pyogenes - follicular tonsillitis;
 Group C and G Streptococci;
 Mycoplasma, Chlamydia, Neisseria subspecies;
 (Pneumococci);
 (Haemophilus influenzae);
 (Moraxella catarrhalis);
 (Staphylococcus subspecies);
 Antibiotics: bacterial infection - physical findings, laboratory findings (blood
count, CRP, ESR, rapid bacteriological test), acute or chronic infection, presence
of immunosuppression.

27
Q
  1. Precancerous lesions of the oral cavity and oropharynx
A 
 Erythroplakia,
 Leukoplakia,
 Lichen planus
 Naevus
 Spongiosus albus mucosae
28
Q
  1. Causes of chronic hoarseness (Why is it necessary to visit an ENT specialist
    after 3 weeks of hoarseness?)
A

 Acute and chronic inflammations of the larynx;
 Benign laryngeal lesions (cysts, granulation, Reinke edema, polyps,
papillomatosis);
 Malignant laryngeal lesions;
 Recurrent laryngeal nerve paresis, (which can be caused by: hypopharyngeal,
thyroid gland, esophageal, pulmonary, mediastinal cancer, intracranial diseases);
 GERD;

It is exceptionally important to diagnose a malignant lesion as soon as we can.

29
Q
  1. Symptoms of laryngeal and hypopharyngeal cancers
A 
 Hoarseness;
 Dyspnea;
 Dysphagia;
 Referred ear pain;
 Globus feeling;
 Hemoptoe;
 Loss of body weight
 Neck lump.
30
Q
  1. Swollen neck lymph nodes – causes
A 
 Non-specific inflammations (e.g. upper respiratory tract infections);
 Specific inflammations:
 - Bacterial: TB, syphilis, cat scratch disease, tularemia,
 - Protozoal: toxoplasmosis,
 - Viral: HIV-infection,
 - Non-infectious: sarcoidosis;
 Lymphomas;
 Metastases of head and neck cancers.
31
Q
  1. Evaluation of neck lumps – diagnostic steps
A
  1. Correct, accurate registration of patient history: e.g. duration of symptoms, upper
    respiratory tract infections, dysphagia, hoarseness;
  2. Careful ENT examination – special attention should be paid to the examination of
    the neck: localization, consistency, sensibility of the lump, its relation to the
    surrounding structures;
  3. Blood tests: inflammation markers, serology;
  4. Imaging modalities: ultrasound, CT/MRI;
  5. US guided Fine Needle Aspiration Biopsy;
  6. For lymphadenomegaly, excision of the node is carried out only if the evaluation
    of the FNAB reveals lymphoma (or, if it is needed by the pathologist).
32
Q
  1. Causes of dyspnea in the upper respiratory tract
A

Upper respiratory tract infections (tonsillitis, epiglottitis, laryngitis);
 Lumps in the upper respiratory tract: abscess, granulation tissue, malignancies;
 Non-specific reactions of the upper respiratory mucosa: allergy, Reinke edema,
hereditary angioneurotic edema;
 Foreign body;
 Stenosis;
 Recurrent laryngeal nerve palsy.

33
Q
  1. Middle-aged, smoker patient presents with unilateral ear pain, but the
    examination of the ear does not reveal any disorders. What may be the cause,
    and what is obligatory to be examined?
A

Unilateral, referred ear pain is a typical finding in patients with hypopharyngeal (less
commonly supraglottic and oropharyngeal) malignancies. This symptom and the
tobacco use in the patient history make the examination of the oral cavity,
oropharynx/hypopharynx, larynx and the neck obligatory.

34
Q
  1. Management of choking patients – if intubation cannot be carried out
A
  1. Cricothyrotomy – in the lack of time and appropriate tools: we find the
    cricothyroid ligament above the cricoid cartilage (using fingers), and after carrying
    out a transversal incision on the skin, we pierce the ligament with any instrument at
    hand, and insert a holed tool (e.g. outer tube of a pen).
  2. Tracheotomy – After incising the skin and the platysma, we find (and if necessary
    - ligate) the isthmus of the thyroid gland, and - at the 2nd or 3rd tracheal cartilage -
    we make an incision on the anterior wall of trachea (in childhood) or remove a part of
    the cartilage (in adults). We insert a tube/cannula in order to maintain the free airway.

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