Minimal Criteria ENT Flashcards
- Symptoms and clinical features of diffuse otitis externa
Symptoms
Earache;
External part of the ear canal is painful (esp. 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.
- Symptoms and clinical features of acute otitis media (AOM) – suppurative form
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.
- Causes of acute hearing loss
-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.
- What is to be done in case of acute sensorineural hearing loss?
In case of acute sensorineural hearing loss, immediate intravenous nootropic/vasodilatating therapy or steroid bolus treatment is necessary w/ 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
- Recognition 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
- Causes of ear pain
- Causes of ear pain
-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.
- Complications of acute otitis media (AOM)
-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.
- Clinical features and symptoms of acute mastoiditis
- Clinical features and symptoms of acute mastoiditis
Associated w/, or following AOM;
Pinna is pushed forward;
The posterior wall of the external ear canal is swollen, seems to be lowered;
Retroauricular pain, Erythema;
Pulsating, severe pain;
Pulsating otorrhea
- Causes of unilateral otitis media with effusion (OME) in adults and childhood.
Chronic dysfunction of the Eustachian tube (Adenoid vegetation or Nasopharyngeal tumor)
In adults, the possibility of a NP tumor must not be left out of consideration!
- How to diagnose vertigo caused by vestibular disorders
- How to diagnose vertigo caused by vestibular disorders
-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.
- Causes of peripherial facial palsy (list)
- Causes of peripherial facial palsy (list)
Bell’s palsy;
Herpes zoster oticus;
Other viral or bacterial infections (HSV, EBV, Lyme);
Middle ear diseases (A/C infections, cholesteatoma, rarely tumors);
Tumors of the pontocerebellar angle, vestibular schwannoma;
Malignant tumors of parotid gland.
Traumas: Cranial (pyramid bone fractures), Extratemporal
- Primary management of epistaxis/nosebleeding (at home/ambulance/by GP)
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
- Management of epistaxis/nosebleeding (anterior, posterior) by ENT professionals
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
- Management and complications of nasal folliculitis and furuncles
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,
arenteral 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.
- Types of rhinitis (list)
- Types of rhinitis
Common infections: Simple acute rhinitis, purulent rhinitis;
Specific forms of Rhinitis: TB, syphilis, sarcoidosis;
Allergic rhinitis
Atrophic rhinitis (Ozena)
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)
- Clinical features and management of angioedema (Quincke-edema)
Sx and Cf:
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.
- Complications of paranasal sinus infections (list)
Extracranial complications Periorbital cellulitis; Subperiosteal abscess; Orbital phlegmone / abscess; Osteomyelitis; Sepsis; Intracranial complications Meningitis; Epi/subdural or brain abscess, encephalitis; Cavernous sinus thrombosis
- Where does the patient localize the pain in cases of frontal, maxillary, ethmoidal or sphenoidal sinusitis?
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
- Causes of unilateral nasal obstruction and discharge in childhood and in adulthood
Childhood: foreign body; sinusitis; nasopharyngeal angiofibroma; Congenital malformation: choanal atresia, meningoencephalocele. Adulthood: NP tumors; deviation of the nasal septum; hypertrophy of turbinates; TRAUMA and it’s late consequences; Dz => nasal cavity Obstruction (POLYP, B/M tumors); rhinosinusitis
- ENT diseases causing headache
- Viral infection of the upper airways;
- Nasal sinuses Inflammations (A/C);
- Nasal sinuses Tumors (B/M);
- Sinusitis&Otitis Cx: mastoiditis, meningitis, brain abscess, petrositis;
- Cervical: cervical vertebra disorders, spondylosis, myalgia;
- Neuralgias;
- Pain of Temporomandibular joint
- Most frequent causes of dysphagia
dysphagia
- GERD;
- Globus feeling, psyhogenic disorders;
- Inflammation in the mesoP, hypoP, L region;
- Tumors in the mesoP, hypoP, L region;
- Neuralgia (n. IX, n. X);
- Sensorial/Motor inn. disorders: sensorial disorders in supraglottical region;
- Foreign bodies in the hypoP and oesophagus;
- Esophageal motility disorders, achalasia;
- Diverticulum (e.g. Zenker);
- Stenoses of hypoP and esophagus , ;
- Indications of tonsillectomy (absolute and relative)
Absolute indications:
rheumatic fever;
peritonsillar abscess;
tonsillogenic sepsis.
Relative indications:
chronic Tonsillitis;
recurrent Tonsillitis;
Tonsillogenic or posttonsillitis focal symptoms;
marked hypertrophy of the Tonsils => mechanical obstruction;
Tonsillar Tumor is suspected;
OSAS or other obstructive sleep-related breathing
disorders;
severe orofacial / dental disorders => narrow upper airways.
- Clinical features and symptoms of peritonsillar abscess
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.
- Peritonsillar abscess – treatment
- Peritonsillar abscess – treatment
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.
- Clinical features, symptoms and complications of para- and retropharyngeal abscesses
Sx: 1. throat and neck pain, 2. Foreign-body sensation, 3. Fever, 4. difficulty in Swallowing, 5. trismus, 6. torticollis, 7. Swelling of the lateral or posterior pharyngeal wall, 8. thick speech, 9. laryngeal/oropharyngeal edema; Cx: 1. oropharyngeal and laryngeal edema, 2. septicemia, 3. mediastinitis, 4. choking.
- Pathogens of tonsillitis and pharyngitis, indication of antibiotic treatment
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), A/C infection, presence of immunosuppression.
- Precancerous lesions of the oral cavity and oropharynx
Erythroplakia, Leukoplakia, Lichen planus Naevus Spongiosus albus mucosae
- Causes of chronic hoarseness (Why is it necessary to visit an ENT specialist after 3 weeks of hoarseness?)
- A/C inflammations of the Larynx;
- Benign Laryngeal lesions (cysts, granulation, Reinke edema, polyps, papillomatosis);
- Malignant Laryngeal lesions;
- Recurrent Laryngeal nerve paresis, (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
- Symptoms of laryngeal and hypopharyngeal cancers
Sx laryngeal + hypopharyngeal cancers: Hoarseness; Dyspnea; Dysphagia; Referred ear pain; Hemoptoe; Globus feeling; Loss of body weight Neck lump.
- Swollen neck lymph nodes – causes:
- 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.
- Evaluation of neck lumps – diagnostic steps
- Correct, accurate registration of patient history: e.g. duration of symptoms, upper
respiratory tract infections, dysphagia, hoarseness; - 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; - Blood tests: inflammation markers, serology;
- Imaging modalities: ultrasound, CT/MRI;
- US guided Fine Needle Aspiration Biopsy;
- 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).
- Causes of dyspnea in the upper respiratory tract
- URT infections (tonsillitis, epiglottitis, laryngitis);
- Lumps in the URT: abscess, granulation tissue, malignancies;
- Non-specific reactions of URT mucosa: allergy, Reinke edema, hereditary angioneurotic edema;
- Foreign body;
- Stenosis;
- Recurrent laryngeal nerve palsy.
- 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?
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.
- Management of choking patients – if intubation cannot be carried out
- 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.