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Otorhinolaryngology > Minimum Criteria > Flashcards

Minimum Criteria Flashcards

1
Q

Symptoms of diffuse otitis externa

A
  • earache
  • external part of the ear canal is painful, especially the tragus
  • discharge, itching
  • ear congesion, hearing loss
  • fever is uncommon
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2
Q

Clinical findings of diffuse otitis externa

A
  • 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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3
Q

Symptoms of acute otitis media – suppurative form

A
  • earache
  • hearing loss
  • nasal discharge and congestion
  • fever, malaise
  • if perforation is present: otorrhea
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4
Q

Clinical features of acute otitis media – suppurative form

A
  • 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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5
Q

Causes of acute hearing loss – conductive type

A
  • wax, foreign body
  • acute tubal occlusion
  • otitis media
  • trauma (ie. perforation of th tympanic membrane)
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6
Q

Causes of acute hearing loss – sensorineural type

A
  • noise (acute) induced hearing loss
  • viral infection
  • vascular causes
  • toxical damage (medication, chemicals)
  • traumas
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7
Q

What is to be done in case of acute sensorineural hearing loss?

A
  • immediate intravenous nootropic/vasodilating therapy or steroid bolus treatment with hospitalization
  • detailed investigation to clarify the etiology
  • the earlier the treatment starts, the better the outcome
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8
Q

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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9
Q

Causes of primary otalgia (ear pain)

A
  • otitis
  • tumors of the ear
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10
Q

Causes of referred/secondary otalgia (ear pain)

A
  • tumors and inflammation of the larynx, pharynx, tonsils, base of the tongue
  • dental inflammations, temporomndibular joint syndrome, neuralgic pain
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11
Q

Extracranial complications of acute otitis media

A

Intratemporal:
- acute mastoiditis
- zygomaticitis
- petrositis
- facial nerve palsy
- labyrinthitis

Extratemporal:
- abscess: subperiosteal, preauricular, suboccipital, Bezold’s abscess

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12
Q

Intracranial complications of acute otitis media

A
  • extradural abscess
  • sinus phlebitis – sinus thrombosis
  • subdural abscess
  • meningitis, encephalitis
  • brain abscess
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13
Q

General complications of acute otitis media

A

sepsis

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14
Q

Clinical features and symptoms of acute mastoiditis

A
  • 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
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15
Q

Causes of unilateral otitis media with effusion in adults and children

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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16
Q

How to diagnose vertigo caused by vestibular disorders?

A

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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17
Q

Causes of peripheral facial palsy

A
  • Bell’s palsy
  • herpes zoster virus
  • other viral or bacterial infections: HSV, EBV, Lyme
  • acute and chronic middle ear diseases: infections, cholesteatoma, rarely tumors
  • tumors of the pontocerebellar angle, vestibular shwannoma
  • cranial traumas (pyramid bone fractures), extratemporal traumas
  • malignant tumors of parotid gland
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18
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/vasoconstrictor solution-imbibed cotton or spongostan should be applied to 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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19
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 nosebleeding: anterior nasal packing
  • posterior nosebleeding: posterior nasal packing (Bellocq tamponade), balloon catheter
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20
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 furnculosis 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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21
Q

Types of rhinitis

A
  • 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

**only 3 are required from the “other” category

22
Q

Clinical features and symptoms of angioedema (Quincke-edema)

A
  • urticaria, edema in the head and neck region
  • dysphagia, globus feeling or visible swelling in the throat, choking
  • in severe form: anaphylaxis
23
Q

Treatment and management of angioedema (Quincke-edema)

A
  • antihistamines, steroids, adrenaline
  • maintaining free airways: cricothyrotomy/tracheotomy – if needed
24
Q

Extracranial complications of paranasal sinus infections

A
  • periorbital cellulitis
  • subperiosteal abscess
  • orbital phlegmone/abscess
  • osteomyelitis
  • sepsis
25
Q

Intracranial complications of paranasal sinus infections

A
  • meningitis
  • epi/subdural or brain abscess, encephalitis
  • cavernous sinus thrombosis
26
Q

Where does the patient localize the pain in cases of sinusitis?

A
  • frontal: forehead
  • maxillary: face
  • ethmoidal: periorbitally, between the eyes
  • sphenoid: crown of the head, referring to the occipital area
  • all forms of sinusitis can cause diffuse headache
27
Q

Causes of unilateral nasal obstruction and discharge in childhood

A
  • foreign body
  • sinusitis
  • nasopharyngeal angiofibroma
  • congenital malformation: choanal atresia, meningoencephalocele
28
Q

Causes of unilateral nasal obstruction and discharge in adulthood

A
  • nasopharyngeal tumors
  • deviation of the nasal septum
  • hypertrophy of turbinates
  • trauma and its late consequences
  • diseases causing nasal cavity obstruction (polyp, benign and malignant tumors)
  • rhinosinusitis
29
Q

ENT diseases causing headache

A
  • viral infection of the upper airways
  • inflammation of nasal sinuses: acute and chronic
  • cervical: cervical vertebral disorders, spondylosis, myalgia
  • complications of otitis and sinusitis: mastoiditis, meningitis, brain abscess, inflammation of the petrous pyramid
  • neuralgias
  • pain of temporomandibular joint
30
Q

Most frequent causes of dysphagia

A
  • GERD
  • globus feeling, psychogenic disorders
  • inflammation in the mesopharyngeal, hypopharyngeal and laryngeal regions
  • tumors in the mesopharyngeal, hypopharyngeal and laryngeal regions
  • neuralgia (n. IX, n. X)
  • sensorial and motor innervation disorders: sensorial disorders in supraglottical region
  • foreign bodies in the hypopharynx and esophagus
  • esophageal motility disorders, achalasia
  • diverticulum (ie. Zenker)
  • esophageal, hypopharyngeal stenoses
31
Q

Absolute indications of tosillectomy

A
  • rheumatic fever
  • peritonsillar abscess
  • tonsillogenic sepsis
32
Q

Relative indications of tonsillectomy

A
  • chronic tonsilitis
  • recurrent tonsilitis
  • tosillogenic 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
  • sever orofacial/dental disorders causing narrow upper airways
33
Q

Clinical features and symptoms of peritonsillar abscesses

A
  • throat pain, referred ear pain
  • difficulty 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
34
Q

Treatment of peritonsillar abscesses

A
  • drainage of the abscess: puncture, incision, daily opening of the abscess cavity
  • tonsillectomy: abscess-tosillectomy, tosillectomy 6 wks after recovery
  • antibiotics, decreasing edema, analgesics, administration of fluids
35
Q

Symptoms of para- and retropharyngeal abscesses

A
  • throat and neck pain
  • foreign-body sensation
  • fever
  • difficulty swallowing
  • trismus
  • torticollis
  • swelling of the lateral or posterior pharyngeal wall
  • thick speech
  • laryngeal/oropharyngeal edema
36
Q

Complications of para- and retropharyngeal abscesses

A
  • oropharyngeal and laryngeal edema
  • septicemia
  • mediastinitis
  • choking
37
Q

Viral pathogens of tonsillitis and pharyngitis

A
  • 80-90%
  • adenovirus, rhinovirus
  • EBV: infectious mononucleosis
38
Q

Bacterial pathogens of tonsillitis and pharyngitis

A
  • streptococcus pyogenes – follicular tonsillitis
  • group C and G streptococci
  • mycoplasma, chlamydia, neisseria subspecies
  • pneumococci
  • hemophilus influenzae
  • moraxella catarrhalis
  • staphylococcus subspecies
39
Q

Indication of antibiotic treatment in case of tonsillitis and pharyngitis

A
  • bacterial infection: physical findings
  • laboratory findings (blood count, CRP, ESR, rapid bacteriological test)
  • acute or chronic infection
  • presence of immunosuppression
40
Q

Precancerous lesions of the oral cavity and oropharynx

A
  • erythroplakia
  • leukoplakia
  • lichen planus
  • naevus
  • spongiosus albus mucosae
41
Q

Causes of chronic hoarseness

A
  • acute and chronic inflammations of the larynx
  • benign laryngeal lesions (cysts, granulation, Reinke edema, polyps, papillomatosis)
  • malignant laryngeal lesions
  • recurrent laryngeal nerve paresis (can be caused by: hypopharyngeal, thyroid gland, esophageal, pulmonary, mediastinal cancer, intracranial diseases)
  • GERD
42
Q

When and why to consult an ENT specialist due to hoarseness?

A
  • after 3 weeks of hoarseness it is necessary to meet an ENT specialist
  • it is exceptionally important to diagnose a malignant lesion as soon as we can
43
Q

Symptoms of laryngeal and hypopharyngeal cancers

A
  • hoarseness
  • dyspnea
  • dysphagia
  • referred ear pain
  • globus feeling
  • hemoptoe
  • loss of body weight
  • neck lump
44
Q

Causes of swollen neck lymph nodes

A
  • non-specific inflammations (ie. 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
45
Q

Evaluation of neck lumps – diagnostic steps

A
  1. correct, acurate registration of patient history (ie. duration of symptoms, upper respiratory tract infections, dysphagia, hoarseness)
  2. careful ENT examination – special attention should be paid to the examination of the neck
  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)
46
Q

Causes of dyspnea in the upper respiratory tract

A
  • 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
47
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.

48
Q

Management of choking patients – if intubation cannot be carried out

A
  1. cricothyrotomy
  2. tracheotomy
49
Q

What is cricothyrotomy?

A

in the lack of time and appropriate tools, it is used to manage choking patients (when intubation cannot be carried out)

  1. cricothyroid ligament (above the cricoid cartilage is found using fingers
  2. transveral incision on the skin
  3. pierce the ligament with any instrument at hand
  4. insert a holed tool (ie. outer tube of a pen)
50
Q

What is tracheotomy?

A

used to manage choking patients if intubation cannot be carried out

  1. incising the skin and the platysma
  2. find (and if necessary, ligate) the isthmus of the thyroid gland
  3. at 2nd/3rd tracheal cartilage, incise the anterior wall of trachea (in children) or remove part of the cartilage (in adults)
  4. insert tube/cannula in order to maintain the free airway

Otorhinolaryngology (1 decks)

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