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ENT > Minimal Criteria ENT > Flashcards

Minimal Criteria ENT Flashcards

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

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.

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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 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

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5
Q
  1. Recognition of hearing loss in childhood
A 
 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
  1. 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.
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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
  1. 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
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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 NP tumor must not be left out of consideration!

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10
Q
  1. How to diagnose vertigo caused by vestibular disorders
A
  1. 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.
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11
Q
  1. Causes of peripherial facial palsy (list)
A
  1. 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
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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,
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.

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15
Q
  1. Types of rhinitis (list)
A
  1. 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)
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16
Q
  1. Clinical features and management of angioedema (Quincke-edema)
A

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.

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:
 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
20
Q
  1. ENT diseases causing headache
A
  1. Viral infection of the upper airways;
  2. Nasal sinuses Inflammations (A/C);
  3. Nasal sinuses Tumors (B/M);
  4. Sinusitis&Otitis Cx: mastoiditis, meningitis, brain abscess, petrositis;
  5. Cervical: cervical vertebra disorders, spondylosis, myalgia;
  6. Neuralgias;
  7. Pain of Temporomandibular joint
21
Q
  1. Most frequent causes of dysphagia
A

dysphagia

  1. GERD;
  2. Globus feeling, psyhogenic disorders;
  3. Inflammation in the mesoP, hypoP, L region;
  4. Tumors in the mesoP, hypoP, L region;
  5. Neuralgia (n. IX, n. X);
  6. Sensorial/Motor inn. disorders: sensorial disorders in supraglottical region;
  7. Foreign bodies in the hypoP and oesophagus;
  8. Esophageal motility disorders, achalasia;
  9. Diverticulum (e.g. Zenker);
  10. Stenoses of hypoP and esophagus , ;
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 => mechanical obstruction;
 Tonsillar Tumor is suspected;
 OSAS or other obstructive sleep-related breathing
disorders;
 severe orofacial / dental disorders => 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
  1. 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.
25
Q
  1. Clinical features, symptoms and complications of para- and retropharyngeal abscesses
A 
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.
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), A/C 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
  1. A/C inflammations of the Larynx;
  2. Benign Laryngeal lesions (cysts, granulation, Reinke edema, polyps, papillomatosis);
  3. Malignant Laryngeal lesions;
  4. Recurrent Laryngeal nerve paresis, (caused by: hypopharyngeal, thyroid gland, esophageal, pulmonary, mediastinal cancer, intracranial diseases);
  5. 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 
Sx laryngeal + hypopharyngeal cancers: 
 Hoarseness;
 Dyspnea;
 Dysphagia;
 Referred ear pain;
 Hemoptoe;
 Globus feeling;
 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
  1. URT infections (tonsillitis, epiglottitis, laryngitis);
  2. Lumps in the URT: abscess, granulation tissue, malignancies;
  3. Non-specific reactions of URT mucosa: allergy, Reinke edema, hereditary angioneurotic edema;
  4. Foreign body;
  5. Stenosis;
  6. 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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