Minimal q Flashcards
- Symptoms and clinical features of diffuse otitis externa
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
- 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 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.
- Recognition of hearing loss in childhood
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
- 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
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
- 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 nasopharyngeal tumor must not be left out of consideration!
- 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)
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
- 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, 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
- Types of rhinitis (list)
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)
- Clinical features and management of angioedema (Quincke-edema)
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
- Complications of paranasal sinus infections (list)
Extracranial complications
Periorbital cellulitis
Subperiosteal abscess
Orbital phlegmone / abscess
Osteomyelitis
Sepsis
Intracranial complications
Meningitis, encephalitis
Epi/subdural or brain abscess
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:
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
- ENT diseases causing headache
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
- Most frequent causes of dysphagia
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
- 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 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
- 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
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
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
- 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), acute or chronic 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?)
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.
- Symptoms of laryngeal and hypopharyngeal cancers
Hoarseness
Dyspnea
Dysphagia
Referred ear pain
Globus feeling
Hemoptoe
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
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
- 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).
- 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.
