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ENT > Minimal Q > Flashcards

Minimal Q Flashcards

1
Q

Symptoms and clinical features of diffuse otitis externa

A

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

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2
Q

Symptoms and clinical features of acute otitis media (AOM) – suppurative
form

A 
Symptoms
1) Earache;
2) Hearing loss;
3) Nasal discharge and congestion;
4) Fever, malaise;
5) If perforation is present: otorrhea
Clinical findings
1) Ear canal appears to be normal;
2) Hyperemia of tympanic membrane;
3) Later in the course of the disease: marked bulging of the tympanic membrane,
subsequently spontaneous perforation can develop.
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3
Q

Causes of acute hearing loss

A

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

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4
Q

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

Recognition of hearing loss in childhood

A

1) the newborn does not react to sounds;
2) tone of crying is unusual;
3) babbling period does not appear;
4) visual orientation is dominant;
5) speech development is delayed;
6) tone, pitch, intensity, melody and rhythm of the speech is pathologic;
7) articulation disorders;
8) worse reading and writing skills

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6
Q

Causes of ear pain

A

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

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7
Q

Complications of acute otitis media (AOM)

A 
Extracranial complications:
- Intratemporal:
1)Acute mastoiditis;
2) Zygomaticitis;
3) Petrositis;
4) Facial nerve palsy;
5) Labyrinthitis;
- Extratemporal:
1) Abscess: subperiosteal, preauricular, suboccipital, Bezold's abscess;
Intracranial complications:
1)Extradural abscess;
2) Sinus phlebitis - sinus thrombosis;
3) Subdural abscess;
4) Meningitis, encephalitis;
5) Brain abscess;

General complications: sepsis.

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8
Q

Clinical features and symptoms of acute mastoiditis

A

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

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9
Q

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

How to diagnose vertigo caused by vestibular disorders

A

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

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11
Q

Causes of peripherial facial palsy (list)

A

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

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12
Q

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

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

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

Types of rhinitis (list)

A

1) Common infections: Simple acute rhinitis, purulent rhinitis;
2) Specific forms of Rhinitis: TB, syphilis, sarcoidosis;
3) Allergic rhinitis
4) Atrophic rhinitis (oezena)
5) Rhinitis sicca anterior.
6) 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

Clinical features and management of angioedema (Quincke-edema)

A

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

17
Q

Complications of paranasal sinus infections (list)

A

Extracranial complications:

1) Periorbital cellulitis;
2) Subperiosteal abscess;
3) Orbital phlegmone / abscess;
4) Osteomyelitis;
5) Sepsis;

Intracranial complications:

1) Meningitis;
2) Epi/subdural or brain abscess, encephalitis;
3) Cavernous sinus thrombosis.

18
Q

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

Causes of unilateral nasal obstruction and discharge in childhood and in
adulthood

A

Childhood:

1) foreign body;
2) sinusitis;
3) nasopharyngeal angiofibroma;
4) congenital malformation: choanal atresia, meningoencephalocele.

Adulthood:

1) nasopharyngeal tumors;
2) deviation of the nasal septum;
3) hypertrophy of turbinates;
4) trauma and it’s late consequences;
5) diseases causing nasal cavity obstruction (polyp, benign and malignant
tumors) ;
6) rhinosinusitis.

20
Q

ENT diseases causing headache

A

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

21
Q

Most frequent causes of dysphagia

A

1) GERD;
2) Globus feeling, psyhogenic disorders;
3) Inflammation in the mesopharyngeal, hypopharyngeal and laryngeal region;
4) Tumors in the mesopharyngeal, hypopharyngeal and laryngeal region;
5) Neuralgia (n. IX, n. X);
6) Sensorial and motor innervation disorders: sensorial disorders in supraglottical
region;
7) Foreign bodies in the hypopharynx and oesophagus;
8) Esophageal motility disorders, achalasia;
9) Diverticulum (e.g. Zenker);
10) Esophageal, hypopharyngeal stenoses;

22
Q

Indications of tonsillectomy (absolute and relative)

A

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

23
Q

Peritonsillar abscess – treatment

A

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

24
Q

Clinical features, symptoms and complications of para- and retropharyngeal
abscesses

A 
Symptoms:
1) throat and neck pain 
2) foreign-body sensation
3)fever
4) difficulty in swallowing,
5) trismus, torticollis
6) swelling of the lateral or posterior pharyngeal wall
7)thick speech
8)laryngeal/oropharyngeal edema;
Complications:
1) oropharyngeal and laryngeal edema
2)septicemia
3) mediastinitis
4) choking
25
Q

Pathogens of tonsillitis and pharyngitis, indication of antibiotic treatment

A

Pathogens:

  • Viral (80-90%);
    1) adenovirus, rhinovirus;
    2) (EBV - infectious mononucleosis);
    • Bacterial:
      1) Streptococcus pyogenes - follicular tonsillitis;
      2) Group C and G Streptococci;
      3) Mycoplasma, Chlamydia, Neisseria subspecies;
      4) (Pneumococci);
      5) (Haemophilus influenzae);
      6) (Moraxella catarrhalis);
      7) (Staphylococcus subspecies);

Antibiotics:

  • bacterial infection
  • physical findings, laboratory findings (blooD count, CRP, ESR, rapid bacteriological test)
  • acute or chronic infection
  • presence of immunosuppression
26
Q

Precancerous lesions of the oral cavity and oropharynx

A

1) Erythroplakia,
2) Leukoplakia,
3) Lichen planus
4) Naevus
5) Spongiosus albus mucosae

NELLS

27
Q

Causes of chronic hoarseness (Why is it necessary to visit an ENT specialist
after 3 weeks of hoarseness?)

A

1) Acute and chronic inflammations of the larynx;

2) Benign laryngeal lesions (cysts, granulation, Reinke edema, polyps,
papillomatosis) ;

3) Malignant laryngeal lesions;

4) Recurrent laryngeal nerve paresis, (which can be 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.

28
Q

Symptoms of laryngeal and hypopharyngeal cancers

A

1) Hoarseness;
2) Dyspnea;
3) Dysphagia;
4) Referred ear pain;
5) Globus feeling;
6) Hemoptoe;
7) Loss of body weight
8) Neck lump.

29
Q

Swollen neck lymph nodes – causes:

A

1) Non-specific inflammations (e.g. upper respiratory tract infections);
2) Specific inflammations:
A) Bacterial: TB, syphilis, cat scratch disease, tularemia,
B) Protozoal: toxoplasmosis,
C) Viral: HIV-infection,
3) Non-infectious: sarcoidosis;
4) Lymphomas;
5) Metastases of head and neck cancers.

30
Q

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).
31
Q

Causes of dyspnea in the upper respiratory tract

A

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

32
Q

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.

33
Q

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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