Minimum Q Flashcards
1
Q
- Symptoms and clinical features of diffuse otitis externa
A
Symptoms: -earache -external part of 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 ear canal -tympanic membrane appears to be normal
2
Q
- Symptoms and clinical features of Acute Otitis Media (AOM) suppurative form
A
Symptoms: -earache -hearing loss -nasal discharge and congestion -fever, malaise -if perforation present-otorrhea Clinical findings: -ear canal appears to be normal -hyperemia of tympanic membrane -later in the course of the disease-marked bulging of TM, subsequently spontaneous perforation can develop
3
Q
- Causes of acute hearing loss
A
Conductive type:
- wax, foreign body
- acute tubal occlusion, otitis media (OME/AOM)
- trauma (eg TM perforation)
Sensorineural type:
- noise (acute) induced hearing loss
- viral infection
- vascular causes
- toxic damage (medication, chemicals)
- traumas
4
Q
- What is to be done in the case of acute sensorineural hearing loss?
A
In case of acute sensorineural hearing loss, Immediate IV nootropic/vasodilating therapy or steroid bolus treatment is necessary with hospitalization; meanwhile detailed investigation is required to be carried out to clarify the etiology. The earlier treatment is started, the better the outcome is.
5
Q
- Recognition of hearing loss in childhood
A
Signs of hearing loss in childhood:
- 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 speech is pathologic
- articulation disorders
- worse reading and writing skills
6
Q
- Causes of ear pain
A
Primary otalgia:
-otitis
-tumors of the ear
Referred ear pain:
-tumors and inflammation of the larynx, pharynx, tonsils, base of tongue
-dental inflammation, TMJ syndrome, neuralgic pain
7
Q
- 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
8
Q
- Clinical features and symptoms of acute mastoiditis
A
- associated with or following AOM
- the pinna is pushed forward
- retroauricular pain, erythema
- posterior wall of the external ear canal is swollen, seems to be lowered
- pulsating, severe pain
- pulsating otorrhea
9
Q
- Causes of unilateral otitis media with effusion (OME) in adults and childhood
A
Chronic dysfunction of Eustachian tube (adenoid vegetation or nasopharyngeal tumor)
In adults, the possibility of nasopharyngeal tumor must not be left out of consideration!
10
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
-spontaneous nystagmus and nystagmus provoked by head movements
11
Q
- 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
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/vasoconstrictor 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
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
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 lesions
- for furunculosis and/or phlegmonous reaction, parenteral antibiotics should be administered, along with vapor coverage
- the infection is usually caused by S. Aureus
- possible complications: facial phlegmone, angular vein thrombophlebitis, cavernous sinus thrombosis
15
Q
- Types of rhinitis (list)
A
- common infections: simple acute rhinitis, purulent rhinitis
- specific forms of rhinitis: TB, sypilis, sarcoidosis
- allergic rhinitis
- atrophic rhinitis (oezena)
- rhinitis sicca anterior
- other causes : idiopathic, vasomotoric, hormonal, drug-induced, rhinitis medicamentosa, occupational (caused by irritants), foodstuffs (must name 3 form “other”)
16
Q
- 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
- 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
- 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 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 adulthood
A
CHILDHOOD -foreign body -sinusitis -nasopharyngeal angiofibroma -congenital malformations: choanal atresia, meningoencephalocele ADULTHOOD -nasopharyngeal tumors -deviation of nasal septum -hypertrophy of turbinates -trauma and it’s late consequences -disease causing nasal cavity obstruction (polyp, benign and malignant tumors) -rhinosinusitis
20
Q
- 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 petrous pyramid
- neuralgias
- pain of TMJ
21
Q
- Most frequent causes of dysphagia
A
- GERD
- globus feeling, psychogenic disorders
- inflammation in the mesopharyngeal, hypopharyngeal, laryngeal region
- tumors in the mesopharyngeal, hypopharyngeal, laryngeal region
- neuralgia (CN IX. X.)
- sensorial and motor innervation disorders: sensorial disorders in supraglottic region
- foreign bodies in hypopharynx and esophagus
- esophageal motility disorders, achalasia
- diverticulum (eg. Zenker)
- esophageal, hypopharyngeal stenoses
22
Q
- 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
-OSAS or other obstructive sleep related breathing disorder
-severe orofacial/dental disorders causing narrow upper airways
23
Q
- Clinical features and symptoms of peritonsillar abscess
A
- throat pain, referred ear pain
- difficulty in swallowing
- trismus, 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 toward the healthy side
24
Q
- Peritonsillar abscess-treatment
A
- drainage of the abscess-puncture, incision, daily opening of the abscess cavity
- tonsillectomy- abscess tonsillectomy or tonsillectomy 6 weeks after recovery
- antibiotics, decreasing edema, analgesics, administration of fluids
25
25. 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
26
27. Precancerous lesions of the oral cavity and oropharynx
Erythroplakia, leukoplakia, lichen planus, naevus, spongiosus albus mucosae
27
28. Causes of chronic hoarseness (why is it necessary to visit an ENT specialist after 3 weeks of hoarseness?)
Acute and chronic inflammation 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
28
29. Symptoms of laryngeal and hypopharyngeal cancers
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Hoarseness
Dyspnea
Dysphagia
Referred ear pain
Globus feeling
Hemoptoe
Loss of body weight
Neck lump
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29
30. Swollen neck lymph nodes-causes:
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Non-specific inflammations (eg URTI)
Specific inflammations:
-bacterial-TB, syphilis, cat scratch disease, tularemia
-viral-HIV infection
-non-infectious -sarcoidosis
Lymphomas
Metastases of head and neck cancers
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30
31. Evaluation of neck lumps-diagnostic steps
1. Correct, accurate registration of patient history e.g. duration of symptoms, URTIs, dysphagia, hoarseness
2. Careful ENT examination-special attention should be paid to the examination of the neck: localization, consistency, sensibility of the lump, it’s relation to surrounding structures
3. Blood tests: inflammation markers, serology
4. Imaging modalities: US, CT/MRI
5. US guided Fine needle aspiration biopsy(cytology)
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
32. Causes of dyspnea in the upper respiratory tract
- URTIs (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
32
33. 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 tobacco use in the patient history make the examination of the oral cavity, oropharynx/hypopharynx, larynx and neck obligatory!
33
34. Management of choking patients-if intubation cannot be carried out
1. Cricothryotomy-in lack of time and appropriate tools, we find the cricothyroid ligament above the cricoid cartilage (using fingers), and after carrying out a transversal incision of 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 playsma, 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 the trachea (in childhood) or remove a part of the cartilage (in adults). We insert a tube/cannula in order to maintain the free airway.
34
26. Pathogens of tonsillitis and pharyngitis, indication of antibiotic treatment
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PATHOGENS
Viral (80-90%):
-adenovirus, rhinovirus
-(EBV-infectious mononucleosis)
Bacterial:
-streptococcus pyogenes-follicular tonsillitis
-group C and G streptococci
-mycoplasma, chlamydia, neisseria subspecies
-(pneumococci)
-(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
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