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ENT > Minimum criteria > Flashcards

Minimum criteria Flashcards

1
Q
  1. Symptoms and clinical features of diffuse otitis externa
A 
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
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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 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
  1. Recognition of hearing loss in childhood
A 
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
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6
Q
  1. Causes of ear pain
A

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

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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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 nasopharyngeal tumor must not be left out of
consideration!

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10
Q
  1. 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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11
Q
  1. Causes of peripheral facial palsy (list)
A

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.

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12
Q
  1. Primary management of epistaxis/nose-bleeding (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/nose-bleeding (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, 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
  1. Types of rhinitis (list)
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.

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

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.

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:
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.
20
Q
  1. ENT diseases causing headache
A

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.

21
Q
  1. Most frequent causes of dysphagia
A

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;

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 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.

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

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

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.

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), acute or chronic 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

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.

29
Q
  1. Symptoms of laryngeal and hypopharyngeal cancers
A 
Hoarseness;
Dyspnea;
Dysphagia;
Referred ear pain;
Globus feeling;
Hemoptoe;
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

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

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.

ENT (1 decks)

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