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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
  • external part of canal painful (tragus)
  • discharge, itching
  • ear congestion, hearing loss
  • fever (uncommon)

CLINICAL FINDINGS:

  • swelling and hyperemia of skin of canal
  • serous/purulent discharge
  • accumulation of debris in canal
  • tympanic membrane normal
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2
Q
  1. Symptoms and clinical features of acute otitis media
A

SYMPTOMS:

  • earache
  • hearing loss
  • nasal discharge and congestion
  • fever, malaise
  • otorrhea (if perforation present) (=ear drainage)

CLINICAL FINDINGS:

  • normal ear canal
  • hyperemia of tympanic membrane
  • later in course of disease: bulging of tympanic membrane, perforation can occur
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3
Q
  1. Causes of acute hearing loss
A

CONDUCTIVE TYPE:

  • wax, foreign body
  • acute tubal occlusion, otitis media
  • trauma (e.g. perforation of TM)

SENSORINEURAL TYPE:

  • noise induced hearing loss
  • viral infection
  • vascular causes
  • toxical damage (medication, chemicals)
  • trauma
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4
Q
  1. What is to be done in case of acute sensorineural hearing loss?
A
  • immediate IV nootropic/ vasodilatation therapy or steroid bolus treatment with hospitalization
  • detailed investigation to clarify etiology
  • the earlier the treatment is started, the better the outcome
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5
Q
  1. Recognition of hearing loss in childhood
A

SIGNS OF HEARING LOSS IN CHILDREN:

  • newborn doesn’t react to sounds
  • tone of crying is unusual
  • babbling period doesn’t appear
  • visual orientation is dominant
  • speech development is delayed
  • tone, pitch, intensity, melody and rhythm of 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 ear

REFERRED EAR PAIN:

  • tumors and inflammation of the larynx, pharynx, tonsils, base of tongue
  • dental inflammation, temporomandibular joint syndrome, neuralgic pain
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7
Q
  1. Complications of acute otitis media
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
  • pinna is pushed forward
  • retroauricular pain, erythema
  • posterior wall of 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 effusions in adults and childhood
A

Chronic dysfunctions 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

EXAMNINATION:

  • deviation, tilting
  • spontaneous nystagmus and nystagmus provoked by head movements
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11
Q
  1. Causes of peripheral facial palsy
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, tumor)
  • tumors of the pontocerebellar angle, vestibular schwannoma
  • cranial traumas (pyramid bone fractures), extra temporal traumas
  • malignant tumors of parotid gland
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12
Q
  1. Primary management of epistaxis/ nose bleeding (at home/ambulance/GP)
A
  • patient should lean forward with open mouth, firm digital pressure to both nasal alae for 10 minutes
  • ephedrine/nasal drop/vasoconstrictor solutions- 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/ nose bleeding (anterior, posterior) by ENT professionals
A
  • BP measurement, antihypertensive treatment if needed
  • visible bleeding source: chemical cauterization (trichloroacetate, silver nitrate) or coagulation (bipolar electrocoagulation)
  • Anterior nasal bleeding: anterior nasal packing
  • Posterior nasal 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
  • patient should avoid picking or squeezing the lesion
  • Furunculosis and/or phlegmonous reactions: parenteral antibiotics + vapor coverage
  • infection is usually by S.Aureus

COMPLICATIONS:

  • facial phlegmone
  • angular vein thrombophlebitis
  • cavernous sinus thrombosis
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15
Q
  1. Types of rhinitis
A
  • common infections: simple acute rhinitis, purulent rhinitis
  • specific forms: TB, syphilis, sarcoidosis
  • Allergic rhinitis
  • Atrophic rhinitis (oezena)
  • Rhinitis sicca anterior
  • other causes: idiopathic, vasomotoric, hormonal, drug-induced, rhinitis medicamentosa, occupational, food
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16
Q
  1. Clinical features and management of angioedema (Quincke-edema)
A

SYMPTOMS + CLINICAL FEATURES:

  • urticaria, edema in head and neck region
  • dysphagia, globus feeling or visible swelling in throat, choking
  • severe form: anaphylaxis

TREATMENT:

  • antihistamines
  • steroids
  • adrenaline
  • maintain free airways
  • cricothyrotomy/tracheotomy if needed
17
Q
  1. Complications of paranasal sinus infections
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 case of frontal, maxillary, ethmoidal or sphenoidal sinusitis?
A
  • Frontal: forehead
  • Maxillary: face
  • Ethmoidal: periorbital, between the eyes
  • Sphenoidal: crown of head, referring to occipital area
  • all forms 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 tumor
  • deviation of nasal septum
  • hypertrophy of turbinates
  • trauma and its late consequences
  • diseases causing nasal cavity obstruction (polyp, benign and malignant tumors)
  • rhinosinusitis
20
Q
  1. ENT diseases causing headache
A
  • viral infection of upper airways
  • inflammation of nasal sinuses (acute + chronic)
  • benign and malignant tumors of nasal sinuses
  • cervical: cervical vertebrae disorders, spondylosis, myalgia
  • complications of otitis and sinusitis: mastoiditis, meningitis, brain abscess, inflammation of petrous pyramid
  • neuralgias
  • pain of TMJ
21
Q
  1. Most frequent causes of dysphagia
A
  • GERD
  • globus feeling, psychogenic disorder
  • inflammation in the mesopharyngeal, hypo pharyngeal and laryngeal region
  • tumors in mesopharyngeal, hypo pharyngeal and laryngeal region
  • neuralgia
  • sensorial and motor innervation disorders: sensorial disorders in supraglottical region
  • foreign bodies in the hypo pharynx and esophagus
  • esophageal motility disorders, achalasia
  • diverticulum (e.g. Zenker)
  • esophageal, hypo pharyngeal stenoses
22
Q
  1. Indications of tonsillectomy (absolute and relative)
A

ABSOLUTE:

  • rheumatic fever
  • peritonsillar abscess
  • tonsillogenic sepsis

RELATIVE:

  • chronic tonsillitis
  • recurrent tonsillitis
  • tonsillogenic or posttonsillitis focal symptoms
  • marked hypertrophy of the tonsils causing mechanical obstruction
  • tonsillar tumor suspicion
  • 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 swallowing
  • trismus (lockjaw), the speech is thick and indistinct
  • oral fetor (bad odor)
  • fever, insomnia, loss of appetite
  • swelling, redness and protrusion of the tonsil, facial arch, palate and uvula; uvula is pushed toward healthy side
24
Q
  1. Peritonsillar abscess- treatment
A
  • drainage of abscess - puncture, incision, daily opening of the abscess cavity
  • tonsillectomy
    • abscess-tonsillectomy
    • tonsillectomy 6 weeks after recovery
  • antibiotics, decreasing edema, analgesics, admin 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 swallowing, trismus, torticollis (twisted neck), swelling of 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, indications of antibiotic treatment
A 
PATHOGENS:
Viral:
  - adenovirus, rhinovirus
  - (EBV)
Bacterial:
  - Strep pyogenes - follicular tonsillitis
  - Group C and G strep
  - mycoplasma, chlamydia, neisseria
  - pneumococci, H.influenzae, Moraxella catarrhalis, staph)

ANTIBIOTICS:
- bacterial infections: physical findings, lab 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 ENT specialist after 3 weeks of hoarseness

A
  • acute or chronic inflammation of larynx
  • benign laryngeal lesion (cysts, granulation, Reinke edema, polyps, papillomatosis)
  • malignant laryngeal lesion
  • recurrent laryngeal nerve paresis (due to hypo pharyngeal, thyroid gland, esophageal, pulmonary, mediastinal cancer, intracranial diseases)
  • GERD
29
Q
  1. Symptoms of laryngeal and hypo pharyngeal 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 RTI)
  • specific inflammations:
    • bacterial: TB, syphilis, cat scratch disease, tularemia
    • protozoal: toxoplasmosis
    • viral: HIV
    • non-infectious: sarcoidosis
  • lymphomas
  • metastasis 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 RTI, dysphagia, hoarseness
  2. Careful ENT examination - special attention should be paid to the examination of the neck: localization, consistency, sensibility of the lump, relation to other structures
  3. Blood test: inflammatory markers, serology
  4. Imaging modalities: US, CT, MRI
  5. US guided FNAB
  6. for lymphadenomegaly, excision of the node is carried out only if the evaluation of the FNAB reveals lymphoma
32
Q
  1. Causes of dyspnea in the upper respiratory tract
A
  • upper RTI (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 typical finding in patients with hypo pharyngeal malignancies. This symptom and the tobacco use in the patient history make the examination of the oral cavity, oropharynx/hypopharynx, larynx and neck obligatory.

34
Q
  1. Management of choking patient- if intubation cannot be carried out
A
  1. Cricothyrotomy: find cricothyroid ligament above 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
  2. Tracheotomy: after incising the skin and platysma, we find the isthmus of the thyroid gland, and at the 2nd or 3rd tracheal cartilage we make an incision on the anterior wall of trachea (children) or remove a part of cartilage (adults). We insert a tube/cannula in order to maintain the free airway.

ENT. (1 decks)

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